Lsrs Meeting Program 2017-2018 PDF

Table
of Contents
Future Annual Meetings -------------------------------------------------------------------------------------------- 3
Continuing Medical Education Credit ---------------------------------------------------------------------------- 4
WiFi Information ------------------------------------------------------------------------------------------------------ 4
Meeting Evaluations ------------------------------------------------------------------------------------------------- 4
Lumbar Spine Research Society at 10 Years -------------------------------------------------------------------- 5
Research Fund Information ---------------------------------------------------------------------------------------- 6
Officers and Committee List ---------------------------------------------------------------------------------------- 8
10th Annual Meeting Program Schedule ---------------------------------------------------------------------- 10
Electronic Poster Index -------------------------------------------------------------------------------------------- 26
Paper Abstracts ------------------------------------------------------------------------------------------------------ 31
Rapid Fire Abstracts ----------------------------------------------------------------------------------------------- 104
Electronic Poster Abstracts -------------------------------------------------------------------------------------- 152
Alphabetical Disclosure Listing and Author Index ---------------------------------------------------------- 218
Membership Directory ------------------------------------------------------------------------------------------- 246
2

VISION: The Lumbar Spine Research Society is a society dedicated to the free exchange of scientific
information regarding the lumbar spine. The society emphasizes open and transparent discussion
of academic research, free from bias.

MISSION: The society’s purpose is to advance our knowledge and understanding of the physiology,
pathologic process, and treatment of lumbar disease through the promotion and discussion of
research, with the goal of improving patient care.

Future Annual Meetings

LSRS 11th Annual Meeting & 6th Annual Instructional Course Lecture
April 5-6, 2018
Sofitel Chicago Water Tower, Chicago, Illinois

LSRS 12th Annual Meeting & 7th Annual Instructional Course Lecture
April 4-5, 2019
Sofitel Chicago Water Tower, Chicago, Illinois

3
___________________________
Continuing Medical Education Credit
This activity has been planned and implemented in accordance with the accreditation requirements and policies
of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the
American Academy of Orthopaedic Surgeons and Lumbar Spine Research Society. The American Academy of
Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 13.5 AMA PRA
Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their
participation in the activity.
CME’s for Neurosurgeons

The AANS manually tracks credits earned from neurosurgery Category 1 AMA/PRA activities not sponsored or
joint-sponsored by the AANS. To add these credits to your file, please forward a copy of your certificate(s) of
attendance to the AANS for processing. Please allow 4-6 weeks for processing. Please mail, fax or e-mail copies
to:
AANS
Member Services Department
5550 Meadowbrook Drive
Rolling Meadows, IL 60008
Fax: (847) 378-0638
E-mail: cme@aans.org
Meeting Wi-Fi Network: Sofitel Meeting

Password: LSRS2017
Login Browser: login.globalsuite.net
2017 Annual Meeting INFORMATION

http://www.lsrs.org/2017meetingpage
MEETING EVALUATION
https://www.surveymonkey.com/r/LSRS2017
Completed evaluations are required to receive a certificate of attendance.

Directions on completing the evaluation: Once you have accessed the evaluation, you can go back to previous
pages in the survey and update existing responses until the survey is finished or until you have exited. If you do
not complete the survey before exiting, your responses will be captured, however you will not see your previous
answers, when you subsequently access the survey form.
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The Lumbar Spine Research Society at 10 years:
This meeting in the spring of 2017 represents the 10th anniversary of the founding of the Lumbar Spine Research
Society. We have certainly come a long way in ten years. The original meeting was organized by invitation only,
and was attended by 55 spinal surgeons. 33 podium presentations were given that day, but the majority of the
time was spent discussing the organization and goals of a new spinal society.
Those goals were to develop a society dedicated to the scientific presentation and discussion of topics concerning
lumbar spinal surgery. In addition, we hoped to host a meeting that was independent of industry funding and
financially free standing. Our hope was to provide an efficient and concise meeting place for the open exchange
of scientifically valid lumbar spine research.
Over the past ten years, we have seen a steady and substantial growth in the society. The original meeting had 41
submitted abstracts for presentation. For 2017, there were 228 scientific abstracts submitted. 42 of these will be
presented from the podium, 30 as a brief podium presentation, and 40 as poster presentations. Attendance has
grown steadily from the original 55 members to 161 attendees at last year’s meeting. In 2013, we began our first
instructional course and this has had steady growth over the past four years. Also in 2013, we awarded our first
research grant recipient. We have now been able to fund a research grant in each of the past four years in order
to provide pilot funding for scientific research.
More importantly our membership has increased steadily. Over the past five years alone, membership has
increased from 77 to 147. Having a dedicated group of members in attendance each year is what has led to our
meeting success. A small meeting, concise, with scientifically sound presentations and ample time for open
discussion, is what has made this one of the most exciting and thought provoking meetings of the year. Our new
members include many recently graduated Neurosurgeons and Orthopedic Surgeons who have completed Spine
Fellowships. This has helped generate the presentation and discussion of cutting edge topics including surgical
approach, techniques, and technology. I welcome you to the 10th annual LSRS meeting. I certainly hope that you
will enjoy the meeting and continue to spread the word that valid scientific information can be disseminated free
of industrial influence or distraction. If not currently a member, please consider joining us. We would love to have
you.
Thomas A. Zdeblick, M.D.

Founding Member of LSRS
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Dear Colleagues:
A core principle of our mission is to promote research in lumbar spine surgery. As a young organization, our
focus was growth and stability. Despite numerous challenges, including our vision to remain as free as possible
from commercial bias and industry involvement, our Society is thriving.
For the first decade of our organization, the members of the LSRS Board of Directors have personally provided
the majority of funding towards this goal.
For the long-term success of the LSRS Research Grant program, we will need members and attendees
to consider donating generously to the Research Fund.
The LSRS Board feels that we are positioned to impact lumbar spine research in a direct and meaningful
way. 100% of the money raised has funded research projects endorsed by the Research Committee and the
Executive Committee. The current goal is to grant $20,000 per year to the best submission. This initial support
has functioned as seed money for eventual NIH submissions. All projects involve active members of the Society.
Please consider making a generous tax-deductible credit card donation to the Research Fund via our website:
LSRS.org
Alternatively, you may make a donation of appreciated stock which has the additional benefit of being exempt
from capital gains tax. Please contact us for details regarding this option.
Please feel free to contact me with any questions.
Thank you for your contribution to the Research Fund.
Sincerely,
Paul A. Anderson, MD
President, LSRS
DONATE TO THE RESEARCH FUND

Thank you!
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LSRS Research Fund
Donations

Platinum Sponsors

$20,000

Robert F. Heary
Bruce V. Darden, II

Gold Sponsors
$10,000

Bradford Currier Regis Haid Tushar Patel
Jeffrey Fischgrund James Harrop Thomas A. Zdeblick
Alexander Ghanayem

Silver Sponsors
5,000

Paul A. Anderson Jeffrey Coe Louis Jenis
Paul and Celia Arnold Michael Gerling Alpesh Patel
Darrel and Anne Brodke Wellington Hsu Clifford Tribus

Bronze Sponsor
$1,000- $4,999

Randy Davis Douglas Orndorff
Douglas Orr

Honorable Benefactor
$500-$999

Raj Rao
Leo Spector

Benefactor
$250-$499

William Abdu Theodore Koreckij Jonathan Sembrano
Kevin Baker Brandon Rebholz Timothy Witham
Jonathan Grauer P. Bradley Segebarth

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2017 LSRS Committee List

Officers Term Ends

President: Paul A. Anderson, MD 2017
President-Elect: Robert F. Heary, MD 2017
Past President: Jeffrey Fischgrund, MD
Past Past President: Bradford Currier, MD
Secretary: Clifford Tribus, MD 2018
Treasurer: James Harrop, MD 2018

Program Committee

Jonathan Grauer, MD Co-Chair 2017
Daniel Sciubba, MD Co-Chair 2018
David Kim, MD 2017
Ira Goldstein, MD 2017
Andrew Daily, MD 2017
Jonathan Sembrano, MD 2017
Timothy Moore, MD 2018
Dean Cho, MD 2018
Scott Daffner, MD 2018
Michael Lee, MD 2018
Alpesh Patel, MD 2018
Matt Chapman, MD 2018

Membership Committee

Wellington Hsu, MD Co-Chair 2017
Jason Savage, MD Co-Chair 2018
Jeffrey Coe, MD 2017
Christopher Shaffrey, MD 2017
Bartoz Wojownik, MD 2017
Don Moore, MD 2017
Theodore Korejki, MD 2017
Kevin Baker, PhD 2018
Michael Steinmetz, MD 2018
Seth Williams, MD 2018
Chi Lim, MD 2018

Planning Committee
Thomas A. Zdeblick, MD Chair 2017
Alexander Ghanayem, MD Chair 2017

Conflict of Interest/Ethics Committee
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Raj Rao, MD Chair 2018
John Heller, MD 2017
Daryll Dykes, MD 2017
David Polly, MD 2017
Harvey Smith, MD 2018
Bartoz Wojewnik, MD 2018
Douglas Orndorff, MD 2018

Website Committee
Kevin Baker, PhD Chair 2017
Shah-Nawaz Dodwad, MD 2018
Cara Sedney, MD 2018
Bartosz Wojewnik, MD 2018
Michael Gerling, MD 2018

Education Committee
Paul Arnold, MD Co-Chair 2017
Louis Jenis, MD Co-Chair 2018
Bradford Currier, MD 2017
James Harrop, MD 2017
Michael Daubs, MD 2017
Gregory Graziano, MD 2017
Scott Tromanhauser, MD 2017
Raymond Hah, MD 2018
Brandon Lawrence, MD 2018
William Lavalle, MD 2018
Jacob Buchowski, MD 2018
Shah-Nawaz Dodwad, MD 2018

Research Committee
Darrel Brodke, MD Co-Chair 2017
Bruce V. Darden, II, MD Co-Chair 2018
Sanford Emery, MD 2017
Michael Fehlings, MD 2017
Boyle Cheng, MD 2017
Leo Spector, MD 2017
Timothy Witham, MD 2017
Erin Hsu, PhD 2018
Timothy Garvey, MD 2018
Cara Sedney, MD 2018
Ira Goldstein, MD 2018

9
Tenth Annual Meeting

OF THE

FOUNDED 2008

April 6-7, 2017

The Sofitel Chicago Water Tower
Chicago, Illinois

President: Paul A. Anderson, MD
Program Chairs: Jonathan Grauer, MD
Daniel Sciubba, MD
Local Arrangements: Thomas A. Zdeblick, MD
Alexander Ghanayem, MD

Scientific Meeting Objectives
• Understand areas of advancement in the field of lumbar surgery.
• Have advanced understanding of Lumbar Spine Trauma Considerations, Intra-
operative Imaging / Tools, and Pain Considerations.
• Learn from experts and colleagues in the field.
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April 6, 2017 - Thursday

7:00-7:10 am Welcome and Opening Comments
Jonathan Grauer, MD
Session #1 Blood Loss / Thromboembolism

Moderators: Andrew Daily, MD and Thomas A. Zdeblick, MD
(7:10-7:37)
7:10-7:15 Paper 1 Efficacy and Safety of High-dose Tranexamic Acid Protocol in Adult Spinal
Deformity – Analysis of 100 Consecutive Cases
James Lin, MD, MS; Jamal Shillingford, MD; Joseph Laratta, MD; Lee Tan, MD; Charla
Fischer, MD; Ronald Lehman, MD; Lawrence Lenke, MD
7:16-7:21 Paper 2 Comparison of Bleeding vs. Clotting Complications after Lumbar Spine Surgery
Haroutioun Boyajian, MD; Olumuyiwa Idowu, BA; William Mosenthal, MD; Lewis Shi,
MD; Michael Lee, MD
7:22-7:27 Paper 3 Pharmacologic Prophylaxis for Venous Thromboembolism in Elective Spine
Surgery
Ryan McLynn, BS; Patawut Bovonratwet, BS; Nathaniel Ondeck, BS; Jonathan Cui, BS;
Taylor Ottesen, BS; Blake Shultz, BA; Jonathan Grauer, MD
7:27-7:37 DISCUSSION
Session # 2 Infections
Moderators: Paul Arnold, MD and Don Moore, MD
(7:37-8:04)
7:37- 7:42 Paper 4 Fever Following Lumbar Fusion Procedures
Fady Hijji, BS; Ankur Narain, BA; Daniel Bohl, MD, MPH; Benjamin Mayo, BA; Dustin
Massel, BS; Krishna Kudaravalli, BS; Kelly Yom, BA; Kern Singh, MD
7:43-7:48 Paper 5 Betadine Irrigation and Intrawound Vancomyin Powder Prevent Wound
Complications Following Lumbosacral Tumor Surgery.
Addisu Mesfin, MD
7:49-7:54 Paper 6 Outcomes of Suprafascial Vacuum Assisted Closure Device in Spine Surgical Site
Infections Management
Swamy Kurra, MBBS; Richard Tallarico, MD; Mike Sun, MD; William Lavelle, MD
Session #3 Complications
Moderators: Jonathan Sembrano, MD and Bartoz Wojewnik, MD
(8:04 - 8:37)
8:04-8:09 Paper 7 Can a surgeon’s demographic factors predict postoperative complication rates
after an elective spinal fusion?
Gurmit Singh, BS; Danielle Chun, MD; Ralph Cook, BS; Joseph Weiner, BS; Michael
Schallmo, BS; Kathryn Barth, BS; Sameer Singh, BS; Ryan Freshman, BS; Alpesh Patel,
MD, FACS; Wellington Hsu, MD
11
8:10-8:15 Paper 8 Adverse Events following Posterior Lumbar Fusion: A Comparison of Spine
Surgeons Perceptions at LSRS and Reported Data for Rates and Risk Factors
Nathaniel Ondeck, BS; Daniel Bohl, MD, MPH; Patawut Bovonratwet, BS; Ryan McLynn,
BS; Jonathan Cui, BS; Andre Samuel, BBA; Matthew Webb, AB; Jonathan Grauer, MD
8:16-8:21 Paper 9 Rates of Mortality Among Lumbar Spine Surgical Procedures and Factors
Associated with its Occurrence Over a Ten Year Period: A Study of 803,949
Patients on the Nationwide Inpatient Sample
Gregory Poorman, BA; John Moon, BS; Samantha Horn, BA; Olivia Bono, BA; Anna-Marie
Francis, BA; Cyrus Jalai, BA; Michael Gerling, MD; Peter Passias, MD
8:22-8:27 Paper 10 Inaccuracies in ICD Coding for Obesity Bias Toward Higher Frequency of Coding
in Patients with Increased Comorbidities and Correlate with Postoperative
Complications: A Limitation for Spine Studies Using Administrative Databases
Ryan McLynn, BS; Benjamin Geddes, MD; Jonathan Cui, BS; Nathaniel Ondeck, BS;
Patawut Bovonratwet, BS; Blake Shultz, BA; Jonathan Grauer, MD
SYMPOSIUM #1 Trauma – AOSpine

Moderators: Moderators: Jens Chapman, MD
(8:37-9:22)
8:37-8:47 A fresh approach to classifying Spine Trauma: the new AO TL fracture
classification system.
Gregory Schroeder, MD
8:47-8:52 Discussion
8:52-9:02 Posttraumatic TL kyphosis – when does it matter?
Christopher Shaffrey, MD
9:07-9:17 Recent insights in recovery from TL SCI. The results of STASCIS and NACTN
databanks
Jefferson Wilson, MD
9:22-9:42 Break
9:22-9:42 Breakout Poster Session -1

Moderators: Bradford Currier, MD and Leo Spector, MD
9:22-9:24 Poster 1 Trends in Primary and Revision Laminectomy in the United States from 2006 to
2014
Comron Saifi, MD; Joseph Laratta, MD; Andrew Pugely, MD; Alejandro Cazzulino, BA;
Edward Goldberg, MD; Ronald Lehman, MD; Lawrence Lenke, MD; Howard An, MD;
Frank Phillips, MD;
9:27-9:29 Poster 2 90-day reimbursements for primary single level posterior lumbar interbody
fusion from commercial and Medicare data
Nikhil Jain, MD; Frank Phillips, MD; Safdar Khan, MD
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9:32-9:34 Poster 3 Development of Common Language Descriptions Correlating with PROMIS
Jason Ferrel, MD; Chong Zhang, MS; Angela Presson, PhD; Rasheed Abiola, MD; Nicholas
Spina, MD; W. Ryan Spiker, MD; Brandon Lawrence, MD; Darrel Brodke, MD
9:37-9:39 Poster 4 PROMIS Physical Function Outcomes in Diabetic Patients Undergoing Lumbar
Spine Surgery
Mathieu Squires, BS;Ashley Neese, BS; Yue Zhang, PhD; Brandon Lawrence, MD; W.
Ryan Spiker, MD; Darrel Brodke, MD
Session #4 Rapid Fire Presentations: General Spine

Moderators: Ira Goldstein, MD and Kevin Baker, PhD
(9:42- 10:31)
9:42-9:44 RF Paper 1 The Effectiveness of Bioskills Module for Simulated Lumbar Pedicle Screw
Instrumentation
Sohaib Hashmi, MD; Barrett Boody, MD; Joseph Maslak, MD; Michael McCarthy, MD;
Alpesh Patel, MD, FACS; Wellington Hsu, MD
9:45-9:47 RF Paper 2 Resident Involvement as a Risk Factor in Anterior Lumbar Fusion Outcomes
Samantha Jacobs, BA; William Ranson, BS; Chierika Ukogu, BA; Jun Kim, MD; John Di
Capua, MHS, BS; Sulaiman Somani, BS; Luilly Vargas, BSN; Samuel Cho, MD
9:48-9:50 RF Paper 3 Assessing Online Patient Education Readability for Spine Surgery Procedures
Ankur Narain, BA; Fady Hijji, BS; William Long, BA; Krishna Modi, BS; Dustin Massel, BS;
Benjamin Mayo, BA; Kern Singh, MD
9:51-9:53 RF Paper 4 Is Physical Therapy Helpful After Lumbar Spine Surgery? A Multivariate Analysis
of 1130 Patients
Ananth Eleswarapu, MD; Srikanth Divi, MD; Lewis Shi, MD; Douglas Dirschl, MD; James
Mok, MD; Christopher Stout, PhD; Michael Lee, MD
9:54-9:56 RF Paper 5 What Are the Differences in Medicare DRG Reimbursement for MIS Deformity
Surgery in Academic vs Private Hospitals in Different Geographic Regions?
Pierce Nunley, MD; Gregory Mundis, MD; Robert Eastlack,MD; Dean Chou, MD;
Christopher Shaffrey, MD; Praveen Mummaneni, MD; International Spine Study Group
(ISSG)
9:57 – 10:07 AM DISCUSSION
Rapid Fire Presentations: Complications

10:07-10:09 RF Paper 6 Prevalence of Pre-Operative Lower Urinary Tract Symptoms Among Patients
Undergoing Elective Lumbar Spine Surgery
Elizabeth Lieberman, MD; Stephanie Radoslovich, BA; Ryan Boone, BS; Valentina Haj,
BS; Jayme Hiratzka, MD; Lynn Marshall, Sc.D.; Jung Yoo, MD
10:10-10:12 RF Paper 7 Risk of Surgical Site Infection and Mortality Following Lumbar Fusion Surgery in
patients with Chronic Steroid Usage and Chronic Methicillin Resistant
Staphylococcus Aureus (MRSA) infection
13
Rabia Qureshi, BS; Dennis Chen, MD; Ali Nourbakhsh, MD; Hamid Hassanzadeh, MD;
Adam Shimer, MD; Francis Shen, MD; Anuj Singla, MD
10:13-10:15 RF Paper 8 The Risk of Postoperative Surgical Site Infection Following Lumbar Spine Surgery
after Exposure to Steroids at the Time of Surgical Intervention
Louis Jenis, MD; Benjamin Cowan, BA
10:16-10:18 RF Paper 9 Associations between Preoperative Hyponatremia and Perioperative
Complications in Lumbar Spinal Fusion
Thomas Bomberger, BA; Joseph Tanenbaum, BS; Daniel Lubelski, MD; Michael
Steinmetz, MD; Edward Benzel, MD; Thomas Mroz, MD
10:19-10:21 RF Paper 10 Thirty-Day Complications of Navigated Versus Conventional Single-Level
Instrumented Posterior Lumbar Fusion: An ACS-NSQIP Analysis
Patawut Bovonratwet, BS; Stephen Nelson, MD; Nathaniel Ondeck, BS; Benjamin
Geddes, MD; Jonathan Grauer, MD
Session #5 Bundled Payments

Moderators: Alpesh Patel, MD and Theodore Koreckij, MD
(10:31 – 10:58)
10:31-10:36 Paper 11 Is There Value in Retrospective 90-day Bundle Payment Models for Lumbar
Spine Fusion Procedures?
Susan Odum, PhD; Bryce Van Doren, MPA, MPH; Leo Spector, MD
10:37-10:42 Paper 12 Incidence of 90 Day Readmissions Following Posterior Lumbar Fusion
Jonathan Cui, BS; Raj Gala, MD; Nathaniel Ondeck, BS; Ryan McLynn, BS; Patawut
Bovonratwet, BS; Blake Shultz, BA; Jonathan Grauer, MD
10:43-10:48 Paper 13 90-day bundled payment for primary single level lumbar
discectomy/decompression: what does ‘big data’ say?
Nikhil Jain, MD; Sohrab Virk, MD; Frank Phillips, MD; Elizabeth Yu, MD; Safdar Khan,
MD

14
Awards, Grants, and Presidential Address
Moderators: Bruce Darden, MD and Thomas Zdeblick, MD
(10:58 - 12:00)
Research Award Announcements
10:58 – 11:00(2min) 2017 Resident and Fellow PASE Awards
Research Grant Recipients
11:00-11:05 (5min) LSRS Research Grant: What we’ve gotten for our money
Bruce V. Darden, II, MD
LSRS Research Committee Chair
11:05-11:08 (3 min) Announcement: 2017 LSRS Research Grant Award Winner
Kevin Baker, Ph.D.
William Beaumont Hospital

11:08-11:18 (10min) 2016 Research Grant Recipient Update
Clinton Devin, MD
Vanderbilt University
“Randomized Clinical Trial to determine Efficacy and Feasibility of Using
Predictive Model Based Calculator as a Shared Decision-Making Tool for
Lumbar Spine Surgery”
11:18-11:25 (7 Min) DISCUSSION
Transfer of Presidents
Introduction: Thomas Zdeblick, MD
11:25-11:30 (5 min) President 2008 - 2011
11:30-11:55 (25 min) PRESIDENTIAL ADDRESS: Paul A. Anderson, MD,
President 2015-2017
11:55 - 12:00 (5 min) Incoming President: Robert F. Heary, MD, 2017-2019
Introduction/Pin Ceremony: Paul A. Anderson, MD

12:00-1:00 Attendees Luncheon (3rd Floor)
Members Business Meeting (1st Floor – Cigale)

15
Session #6 Deformity 1
Moderators: Clifford Tribus, MD and D. Kojo Hamilton, MD
(1:00 – 1:27)
1:00-1:05 Paper 14 National Trends for Spinal Deformity Surgery throughout the United States
Comron Saifi, MD; Joseph Laratta, MD; Joseph Lombardi, MD; Jamal Shillingford, MD;
Nathan Hardy, BS; Andrew Pugely, MD; Frank Phillips, MD; Ronald Lehman, MD; Howard
An, MD; Lawrence Lenke, MD
1:06-1:11 Paper 15 A Predictive Nomogram for Clinical Outcomes following Surgical Correction of
Adult Spinal Deformity
Akshay Sharma, BA; Syed Mehdi, BS; Sagar Vallabh, MS; Emily Hu, BA; Joseph
Tanenbaum, BS; Michael Steinmetz, MD; Edward Benzel, MD; Thomas Mroz, MD; Jason
Savage, MD
1:12-1:17 Paper 16 Frailty and Health Related Quality of Life Improvement Following Adult Spinal
Deformity Surgery
Daniel Reid, MD, MPH; Alan Daniels, MD; Tamir Ailon, MD; Justin Smith, MD;
Christopher Shaffrey, MD; Virginie Lafage, PhD; Robert Hart, MD; Emily Miller, MD; Shay
Bess, MD; Christopher Ames, MD

Session #7 Deformity 2
Moderators: William Lavelle, MD and Joshua Heller, MD
(1:27 – 2:00)
1:27-1:32 Paper 17 Outcomes of Open Staged Corrective Surgery in the Setting of Adult Spinal
Deformity
Peter Passias, MD; Gregory Poorman, BA; Michael Gerling, MD; Breton Line, BS; Bassel
Diebo, MD; Samantha Horn, BA; Virginie Lafage, PhD; Shay Bess, MD; Thomas Errico,
MD; International Spine Study Group (ISSG)
1:33-1:38 Paper 18 Visual Loss Following Spine Surgery: What Have We Seen Within the Scoliosis
Research Society (SRS) Morbidity and Mortality Database?
Jamal Shillingford, MD; Joseph Laratta, MD; Nana Sarpong, MD, MBA; Ronald Lehman,
MD; Lawrence Lenke, MD; Charla Fischer, MD
1:39-1:44 Paper 19 Outcomes of Lumbopelvic Fixation for the Treatment of Adult Deformity with a
Modified Iliac Screw Starting Point
Ehsan Jazini, MD; Kevin Khalsa, MD; Tristan Weir, BS; Kelley Banagan, MD; Eugene Koh,
MD, PhD; Steven Ludwig, MD; Daniel Gelb, MD; Luke Brown, MD
1:45-1:50 Paper 20 Instrumentation Complication Rates Following Spine Surgery: A Report from the
Scoliosis Research Society (SRS) Morbidity and Mortality Database
Jamal Shillingford, MD; Joseph Laratta, MD; Nana Sarpong, MD, MBA; Ronald Lehman,
MD; Lawrence Lenke, MD; Charla Fischer, MD
1:50 – 2:00 DISCUSSION

16
Symposium #2 Strategies for Management of Persistent Pain After Surgery
Moderators: Dean Chou, MD
(2:00 – 2:45)
2:00-2:05 (5min) Introduction
Dean Chou, MD
2:05-2:15 (10min) Structural workup of the patient with persistent pain after surgery
Wellington Hsu, MD
2:15-2:25 (10min) Interventional therapies for the patient with persistent pain after surgery
Ankit Mehta, MD
2:25-2:35 (10min) Non-pharmacologic therapies for the patient with persistent pain after surgery
Jason Savage, MD
2:35-2:45 (10 min) Discussion
2:45-3:05 Break
Moderators: Scott Daffner, MD and Timothy Witham, MD
2:45-2:47 Poster 5 Radiographic and Clinical Outcomes of Anterior and Transforaminal Lumbar
Interbody Fusions: A Systematic Review and Meta-Analysis of Comparative
Studies
Remi Ajiboye, MD; Haddy Alas, BA; Akshay Sharma, BA; Sina Pourtaheri, MD
2:50-2:52 Poster 6 Open fixation and fusion versus percutaneous pedicle screw fixation for
treatment of thoracolumbar flexion distraction injuries
Assem Sultan, MD; Joseph Drain, MD; Jonathan Belding, MD; Michael Kelly, MD; James
Liu, MD; Michael Steinmetz, MD; Timothy Moore, MD
2:55-2:57 Poster 7 Hospital Ownership and Teaching Status Affects Perioperative Outcomes
Following Lumbar Spinal Fusion
Wesley Durand, ScB; Joseph Johnson, ScB; Neill Li, BS, MD; JaeWon Yang, BA; Adam
Eltorai, BA; J. Mason DePasse, MD; Alan Daniels, MD
3:00-3:02 Poster 8 In Hospital Narcotic Usage Is Significantly Lower for Minimally Invasive Spine
Surgery Versus Open Spine Surgery
David Falk, MD Student; Michael Hoy, MD Student; Darshan Vora, MD Student; Natalie
Studdard, NP; Warren Yu, MD; Joseph O’Brien, MD, MPH

Session #8 Rapid Fire Presentations: Imaging

Moderators: Louis Jenis, MD and Scott Tromanhauser, MD
(3:05 – 3:55)
3:05-3:07 RF Paper 11 The Prevalence of Spinal Epidural Lipomatosis On Magnetic Resonance Imaging
17
Nina Theyskens, MD; Nuno Paulino Pereira, MD; Stein Janssen, MD; Thomas Cha, MD,
MBA; Joseph Schwab, MD, MS
3:08-3:10 RF Paper 12 Validating The Clinical Significance of The CARDS Classification For Degenerative
Spondylolisthesis Through Preoperative Outcome Measures
Rasheed Abiola, MD; Jason Ferrel, MD; Nicholas Spina, MD; W. Ryan Spiker, MD;
Brandon Lawrence, MD; Darrel Brodke, MD
3:11-3:13 RF Paper 13 Utility of Supine Lateral Radiographs in Assessment of Lumbar Segmental
Instability in Degenerative Lumbar Spondylolisthesis
Foster Chen, MD; Sandip Tarpada, BA; Woojin cho, MD, PhD
3:14-3:16 RF Paper 14 2-5 Year Follow Up on S2AI Pelvic Fixation
Evan Smith, MD; Justin Kyhos, MD; Robert Dolitsky, MD; Warren Yu, MD; Joseph
O’Brien, MD, MPH
3:17-3:19 RF Paper 15 Radiographic Analysis of Psoas Morphology and its Association with
Neurovascular Structures at L4-5
Philip Louie, MD; Ankur Narain, BA; Fady Hijji, BS; Alem Yacob, MD; Bryce Basques, MD;
Kelly Yom, BA; Frank Phillips, MD; Kern Singh, MD
Rapid Fire Presentations: Surgical Techniques

3:30-3:32 RF Paper 16 National Trends in the Utilization of Vertebroplasty and Kyphoplasty Procedures
throughout the United States
Joseph Laratta, MD; Nathan Hardy, BS; Jamal Shillingford, MD; Joseph Lombardi, MD;
James Lin, MD, MS; Comron Saifi, MD; Andrew Pugely, MD; Charla Fischer, MD;
Lawrence Lenke, MD; Ronald Lehman, MD
3:33-3:35 RF Paper 17 A Retrospective Study of Thoracolumbar Burst Fractures Treated with Fixation
and Non-fusion Surgery of Intra-vertebral Bone Graft Assisted with Balloon
Kyphoplasty
Chengmin Zhang, PhD; Paul Arnold, MD; Qiang Zhou, MD
3:36-3:38 RF Paper 18 Radiographic Evaluation of Percutaneous Pedicle Screw Constructs Including
Minimally Invasive Facet Fusions for Unstable Spinal Column Injuries
Daniel Cavanaugh, MD; Tristan Weir, BS; Kelley Banagan, MD; Eugene Koh, MD, PhD;
Daniel Gelb, MD; Steven Ludwig, MD; Luke Brown, MD
3:39-3:41 RF Paper 19 Clinical and Radiographic Analysis of Expandable versus Static Lateral Lumbar
Interbody Fusion Devices with One-Year Follow-up
Joseph O’Brien, MD, MPH; Daina Brooks, BS; Ingrid Luna, MPH; Gita Joshua, MA;
Richard Frisch, MD
3:42-3:44 RF Paper 20 National Treatment Trends and Perioperative Outcomes of Surgical Options for
Degenerative Spondylolisthesis: An ACS-NSQIP study with comparison to prior
LSRS survey results
Patawut Bovonratwet, BS; Matthew Webb, AB; Nathaniel Ondeck, BS; Jonathan Cui, BS;
Ryan McLynn, BS; Kadimcherla Praveen, MD; David Kim, MD; Jonathan Grauer, MD
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Session #9 OR Tools
Moderators: Raymond Hah, MD and Gregory Graziano, MD
(3:55 – 4:22)
3:55-4:00 Paper 21 Bone Morphogenetic Protein Use in Lumbar Spine Surgery in The United States:
How Have We Responded to The Warnings?
Javier Guzman, MD; Robert Merrill, BS; Jun Kim, MD; Samuel Overley, MD ; James
Dowdell, MD; Sulaiman Somani, BS; Andrew Hecht, MD; Samuel Cho, MD;
Sheeraz Qureshi, MD, MBA
4:01-4:06 Paper 22 National Trends in the Utilization of Intraoperative Neuromonitoring throughout
the United States
Joseph Laratta, MD; Nathan Hardy, BS; Jamal Shillingford, MD; Joseph Lombardi, MD;
Comron Saifi, MD; Andrew Pugely, MD; Howard An, MD; Frank Phillips, MD; Ronald
Lehman, MD; Lawrence Lenke, MD
4:07-4:12 Paper 23 Circumferential Fusion: A Comparative Analysis Between ALIF and TLIF for the
Indication of L5-S1 Isthmic Spondylolisthesis
Erik Tye, BA; Andrea Alonso, BS; Joseph Tanenbaum, BS; Roy Xiao, BA; Thomas Mroz,
MD; Michael Steinmetz, MD; Jason Savage, MD

4:22 Announcements
4:30 Adjourn

19
April 7, 2017 - Friday

7:00 -7:10 Opening Remarks
Daniel Sciubba, MD
Session #10 Minimally Invasive Surgery

Moderators: Jeffrey Fischgrund, MD and Chi Lim, MD
(7:10-7:37)
7:10-7:15 Paper 24 Treatment of Chronic Low Back Pain via Ablation of the Basivertebral Nerve:
Results of the SMART Trial
Alfred Rhyne, MD; Jeffrey Fischgrund, MD; Rick Sasso, MD; Hyun Bae, MD; Eeric
Truumees, MD; Philip Yuan, MD; Michael DePalma, MD; Bernhard Meyer, MD; Jorg
Franke, MD
7:16-7:21 Paper 25 Trend of Spine Surgeries In the Outpatient Hospital Setting vs. Ambulatory
Surgical Center
Olumuyiwa Idowu, BA; Haroutioun Boyajian, MD; Edwin Ramos, MD; Lewis Shi, MD;
Michael Lee, MD
7:22-7:27 Paper 26 Body Mass Index is Not Associated with Inpatient Pain Scores or Postoperative
Narcotic Consumption following a Minimally Invasive Transforaminal Lumbar
Interbody Fusion
Ankur Narain, BA; Fady Hijji, BS; Dustin Massel, BS; Benjamin Mayo, BA; Daniel Bohl,
MD, MPH; Krishna Kudaravalli, BS; Kelly Yom, BA; Kern Singh, MD
7:27 -7:37 DISCUSSION
Session # 11 Minimally Invasive Techniques

Moderators: Tushar Patel, MD and Wellington Hsu, MD
(7:37-8:04)
7:37- 7:42 Paper 27 An Analysis of Robotic Assisted Pedicle Screw Placement
Joseph Lombardi, MD; Joseph Laratta, MD; Jamal Shillingford, MD; Mark Weidenbaum,
MD; Ronald Lehman, MD; Charla Fischer, MD
7:43-7:48 Paper 28 Postoperative Outcomes Following Primary Minimally Invasive Transforaminal
Lumbar Interbody Fusion with Unilateral or Bilateral Interbody Cages
Ankur Narain, BA; Fady Hijji, BS; Krishna Kudaravalli, BS; Kelly Yom, BA; Kern Singh, MD
7:49-7:54 Paper 29 Lateral lumbar interbody fusion approach and relationship of the ureter:
Anatomical study with application to minimizing complications
Doniel Drazin, MD, MA; Vlad Voin, NA; Filipe Sanders, NA; Marios Loukas, MD, PhD; Rod
Oskouian, MD; R. Tubbs, PhD
7:54-8:04 AM DISCUSSION

20
Session #12 Preclinical Studies
Moderators: Jason Savage, MD and Erin Hsu, PhD
(8:04- 8:37)
8:04-8:09 Paper 30 Pain-Related Functional Changes in a Rodent Model of Intervertebral Disc
Degeneration
Elizabeth Leimer, BS; Matthew Gayoso; Liufang Jing, MS; Adam Elkhayat, BS; Lori
Setton, PhD Munish Gupta, MD
8:10-8:15 Paper 31 Comparison of the Efficacy of Adipose-Derived and Bone Marrow-Derived Stem
Cells in a Rat Model of Spinal Fusion
Christina Holmes, PhD; Wataru Ishida, MD; Benjamin Elder, MD, PhD; John Locke;
Timothy Witham, MD
8:16-8:21 Paper 32 Intrawound Tobramycin Powder Eradicates Surgical Wound Contamination: An
in Vivo Rabbit Study
Joseph Laratta, MD; Jamal Shillingford, MD; Nathan Hardy, BS; Joseph Lombardi, MD;
Comron Saifi, MD; Alexander Romanov, DVM; Charla Fischer, MD; Ronald Lehman, MD;
Lawrence Lenke, MD; K Riew, MD
8:22-8:27 Paper 33 Topical Intraoperative Antibiotic Administration and Fusion: A Comparison of
Vancomycin and Tobramycin in a Rat Model.
Wataru Ishida, MD; Christina Holmes, PhD; Benjamin Elder, MD, PhD; John Locke;
Timothy Witham, MD
8:27-8:37 AM DISCUSSION
Symposium #3 Intra-Operative Imaging/Tools for Lumbar Surgery

Moderators: Paul Arnold, MD and Clifford Tribus, MD
(8:37 – 9:24)
8:37-8:42 Introduction
Paul Arnold, MD
8:43-8:53 Intraoperative Navigation – options and utility
David Polly, MD
8:53-9:03 Robotics – useful or too early
Harvey Smith, MD
9:03-9:13 Radiation – minimizing exposure to patient and surgeon
Glenn Rechtine, MD
9:14-9:24 Discussion (10 min)

21
9:24-9:44 BREAK
Moderators: James Harrop, MD and Alexander Ghanayem, MD
9:24-9:26 Poster 9 Efficacy of Anti-fibrinolytics and When They Reduce Blood Loss During Spinal
Deformity Surgery
Swamy Kurra, MBBS; Benjamin Meath, BS; Akshay Yadhati, MD; Richard Tallarico, MD;
Mike Sun, MD; William Lavelle, MD
9:29-9:31 Poster 10 The Use of Liberal Transfusion Triggers: Outcomes after Spine Surgery
Taylor Purvis, BS; Rafael De la Garza-Ramos, MD; C. Rory Goodwin, MD, PhD; Steven
Frank, MD; Timothy Witham, MD; Daniel Sciubba, MD
9:34-9:36 Poster 11 Cigarette Smoke-Induced Inhibition of Osteogenesis Through Involvement of the
Aryl Hydrocarbon Receptor
Chawon Yun, PhD; Andrew Schneider, MD; Karina Katchko, BS; Gurmit Singh, BS;
Jonghwa Yun; Andrew George, BS; Nehal Samra; Sohyun Lee; Wellington Hsu, MD; Erin
Hsu, PhD
9:39-9:41 Poster 12 Minimally invasive retroperitoneal anterolateral psoas-sparing (ATP)
lumbosacral fusion: Is it safe?
Chadi Tannoury, MD; Tony Tannoury, MD; Brian Mercer, MD
SESSION #13 Patient Satisfaction

Moderator: Shah-Nawaz Dodwad, MD and Seth Williams, MD
(9:44 – 10:11)
9:44-9:49 Paper 34 The Effectiveness of Personalized Electronic Patient Engagement Messaging
Following Lumbar Spinal Fusion: A Pilot Study
Louis Jenis, MD; Tricia Gordon, NP; Thomas Cha, MD, MBA; Joseph Schwab, MD, MS
9:50-9:55 Paper 35 Preoperative Mental Health May Not Be Predictive of Improvements in Patient
Reported Outcomes Following a Minimally Invasive Transforaminal Lumbar
Interbody Fusion
Fady Hijji, BS; Ankur Narain, BA; Benjamin Mayo, BA; Dustin Massel, BS; Daniel Bohl,
MD, MPH; Kelly Yom, BA; Krishna Kudaravalli, BS; Kern Singh, MD
9:56-10:01 Paper 36 Validation and Utility of the Patient Reported Outcomes Measurement
Information System (PROMIS®) in Patients with Lumbar Stenosis with or without
Spondylolisthesis
Hemil Maniar, MD; Wellington Hsu, MD; Surabhi Bhatt, BS; Jason Savage, MD; Alpesh
Patel, MD, FACS

22
Session #14 Outcomes / Policy
Moderators: Timothy Moore, MD and Douglas Orndorff, MD
(10:11 – 10:38)
10:11-10:16 Paper 37 An Analysis of Conflicts of Interest in Lumbar Spine Surgery: The Effects of
Industry Payments on Practice Patterns and Complication Rates
Gurmit Singh, BS; Ralph Cook, BS; Joseph Weiner, BS; Michael Schallmo, BS; Danielle
Chun, MD; Sameer Singh, BS; Kathryn Barth, BS; Alpesh Patel, MD, FACS; Wellington Hsu,
MD
10:17-10:22 Paper 38 Hospital Competitive Intensity Predicts Perioperative Outcomes Following
Lumbar Spinal Fusion
Wesley Durand, ScB; Joseph Johnson, ScB; Neill Li, BS, MD; JaeWon Yang, BA; Adam
Eltorai, BA; J. Mason DePasse, MD; Alan Daniels, MD
10:23-10:28 Paper 39 Discriminative Ability of Commonly Used Comorbidity Indices: A Comparison of
ASA, the modified Charlson Comorbidity Index, and the modified Frailty Index
Nathaniel Ondeck, BS; Daniel Bohl, MD, MPH; Patawut Bovonratwet, BS; Ryan McLynn,
BS; Jonathan Cui, BS; Blake Shultz, BA; Adam Lukasiewicz, MSc; Jonathan Grauer, MD
Session #15 Lumbar Degenerative

Moderators: Michael Lee, MD and Hemil Maniar, MD
(10:38– 11:08)
10:38-10:43 Paper 40 Comparative Effectiveness between Primary and Revision Foraminotomy for the
Treatment of Lumbar Foraminal Stenosis
Emily Hu, BA; Jianning Shao, BA; Heath Gould, BS; Roy Xiao, BA; Colin Haines, MD; Don
Moore, MD; Thomas Mroz, MD; Michael Steinmetz, MD
10:44-10:51 Paper 41 Decompression Versus Fusion for Grade I Degenerative Spondylolisthesis: A
Meta-Analysis
Scott Koenig, BS; Julio Juaregui, MD; Mark Shasti, MD; Luke Brown, MD; Steven Ludwig,
MD; Daniel Gelb, MD; Kelley Banagan, MD; Eugene Koh, MD, PhD
10:52-10:57 Paper 42 Effect of Lumbar Fusion on Adjacent Segment Disc Deformation: an In-Vivo Pre
and Post-Fusion Surgery Patient Analysis
Thomas Cha, MD, MBA; Kamran Khan, MS; Yan Yu, MD, PhD; Kirkham Wood, MD;
Guoan Li, PhD
Session #16 Rapid Fire Presentations- Preclinical Studies / Other

Moderators: Robert F. Heary, MD and Ankit Mehta, MD
(11:08 – 12:00)
11:08-11:10 RF Paper 21 Combined Treatment with High-Dose Parathyroid Hormone (PTH 1-34) and Low
Dose Bone Morphogenetic Protein 2 (BMP-2) in a Rabbit Spinal Fusion Model
Christina Holmes, PhD; Benjamin Elder, MD, PhD; Wataru Ishida, MD; Sheng-Fu Lo, MD;
Maritza Taylor, BA; John Locke; Timothy Witham, MD

23
11:11-11:13 RF Paper 22 Intradiscal Injection of Polymethyl-Methacrylate/Hyaluronic Acid in an Ovine
Model of Degenerative Disc Disease: Long-Term Disc Appearance on MRI
Arvin Wali, BA; David Santiago-Dieppa, MD; Reid Hoshide, MD; Natalie Taylor, BS;
Gloria Lin, PhD; Nick Manesis, PhD; William Taylor, MD
11:14-11:16 RF Paper 23 Tissue Engineered Bone Graft with Hypertrophic Chondrocytes Prevents Fusion
in an Athymic Rat Model
Comron Saifi, MD; Joseph Laratta, MD; Jamal Shillingford, MD; Jonathan Bernhard, PhD;
Petros Petridis; Samuel Robinson, BS; Mark Weidenbaum, MD; Ronald Lehman, MD;
Gordana Vunjak-Novakovic, MS, PhD; Lawrence Lenke, MD
11:17-11:19 RF Paper 24 The Role of Calcium Pyrophosphate Dihydrate Deposition in Postoperative
Outcome of Lumbar Spinal Stenosis Patients
Thanase Ariyawatkul, MD; Panya Luksanapruska, MD; Witchate Pichaisak, MD;
Cholavech Chavasiri, MD; Sirichai Wilartratsami, MD; Visit Vamvanij, MD
11:20-11:22 RF Paper 25 Treatment of the Fractional Curve with Circumferential Minimally Invasive
(cMIS) Interbody versus Open Surgery: An Analysis of Surgical Outcomes
Dean Chou, MD; Praveen Mummaneni, MD; Pierce Nunley, MD; Robert Eastlack, MD;
Stacie Nguyen, MPH; Gregory Mundis, MD; International Spine Study Group (ISSG)
Rapid Fire Presentations- Deformity

11:34-11:36 RF Paper 26 Radiographic Sagittal Alignment in the Asymptomatic Elderly: What is Normal
for Age?
David McConda, MD; Susan Odum, PhD; Todd Chapman, MD; P. Brad Segebarth, MD
11:37-11:39 RF Paper 27 Effect of Lumbosacral Fusion Alignment on the Biomechanics of the Proximal
Lumbar Segments in Standing and Sitting Postures
Avinash Patwardhan, PhD; Saeed Khayatzadeh, PhD; Antonio Faundez, MD; Robert
Havey, MS; Leonard Voronov, MD, PhD; Alexander Ghanayem, MD; Jean-Charles Le
Huec, MD
11:40-11:42 RF Paper 28 Utility of Intraoperative Rotational Thromboelastometry in Thoracolumbar
Deformity Surgery
Jian Guan, MD; Meic Schmidt, MD, MBA; Andrew Dailey, MD

11:43-11:45 RF Paper 29 Cost Implications of Primary versus Revision surgery in Adult Spinal Deformity
Rabia Qureshi, BS; Varun Puvanesarajah, BS; Amit Jain, MD; Khaled Kebaish, MD; Adam
Shimer, MD; Francis Shen, MD; Hamid Hassanzadeh, MD
11:46-11:48 RF Paper 30 A Spine in Limbo: Does the Difference Between Standing and Supine Spino-
Pelvic Measurements of Patients With Adult Spinal Deformity Affect Surgical
Decision Making?
Khushdeep Vig, BA; Awais Hussain, BA; Robert Merrill, BS; Jun Kim, MD; James Dowdell,
MD; Nathan Lee, BS; John Di Capua, MHS, BS; Samantha Jacobs, BA; Chierika Ukogu, BA;
Samuel Cho, MD
24
12:00 Closing remarks

12:05pm Adjourn

25

FOUNDED 2008

ELECTRONIC

POSTER INDEX

26
Electronic Poster Index 2017

Poster #1 Trends in Primary and Revision Laminectomy in the United States from 2006 to 2014
Comron Saifi, MD; Joseph Laratta, MD; Andrew Pugley, MD; Alejandro Cazzulino, BA;
Edward Goldberg, MD; Ronald Lehman, MD; Lawrence Lenke, MD; Howard An, MD;
Frank Phillips, MD
Poster #2 90-day reimbursements for primary single level posterior lumbar interbody fusion
from commercial and Medicare data
Nikil Jain, MD; Frank Phillips, MD; Safdar Khan, MD
Poster #3 Development of Common Language Descriptions Correlating with PROMIS
Jason Ferrel, MD; Chong Zhang, MS; Angela Presson, PhD; Rasheed Abiola, MD;
Nicholas Spina,MD; W. Ryan Spiker, MD; Brandon Lawrence, MD; Darrel Brodke, MD
Poster #4 PROMIS Physical Function Outcomes in Diabetic Patients Undergoing Lumbar Spine
Surgery
Mathieu Squires, BS; Ashley Neese, BS; Yue Zhang, PhD; Brandon Lawrence, MD; W.
Ryan Spiker, MD; Darrel Brodke, MD
Poster #5 Radiographic and Clinical Outcomes of Anterior and Transforaminal Lumbar Interbody
Fusions: A Systematic Review and Meta-Analysis of Comparative Studies
Remi Ajiboye, MD; Haddy Alas, BA; Akshay Sharma, BA; Sina Pourtaheri, MD
Poster #6 Open fixation and fusion versus percutaneous pedicle screw fixation for treatment of
thoracolumbar flexion distraction injuries
Assem Sultan, MD; Joseph Drain, MD; Jonathan Belding, MD; Michael Kelly, MD; James
Liu, MD; Michael Steinmetz, MD; Timothy Moore, MD
Poster #7 Hospital Ownership and Teaching Status Affects Perioperative Outcomes Following
Lumbar Spinal Fusion
Wesley Durand, ScB; Joseph Johnson, ScB (2018); Neill Li, BS, MD; JaeWon Yang, BA;
Adam Eltorai, BA; J. Mason DePasse, MD; Alan Daniels, MD
Poster #8 In Hospital Narcotic Usage Is Significantly Lower for Minimally Invasive Spine Surgery
Versus Open Spine Surgery
David Falk, MD Student; Michael Hoy, MD Student; Darshan Vora, MD Student; Natalie
Studdard, NP; Warren Yu, MD; Joseph O’Brien, MD, MPH
Poster #9 Efficacy of Anti-fibrinolytics and When They Reduce Blood Loss During Spinal
Deformity Surgery
Swamy Kurra, MBBS; Benjamin Meath, BS; Akshay Yadhati, MD; Richard Tallarico, MD;
Mike Sun, MD; William Lavelle, MD
Poster #10 The Use of Liberal Transfusion Triggers: Outcomes after Spine Surgery
Taylor Purvis, BS; Rafael De la Garza-Ramos, MD; C. Rory Goodwin, MD/PhD; Steven
Frank, MD; Timothy Witham, MD; Daniel Sciubba, MD
Poster #11 Cigarette Smoke-Induced Inhibition of Osteogenesis Through Involvement of the Aryl
Hydrocarbon Receptor
Chawon Yun, PhD; Andrew Schneider, MD; Karina Katchko, BS; Gurmit Singh, BS;
Jonghwa Yun; Andrew George, BS; Nehal Samra; Sohyun Lee; Wellington Hsu, MD; Erin
Hsu, PhD
27

Poster #12 Minimally invasive retroperitoneal anterolateral psoas-sparing (ATP) lumbosacral
fusion: Is it safe?
Chadi Tannoury, MD; Tony Tannoury, MD; Brian Mercer, MD
Poster #13 Effect of Local Delivery of SDF-1 and Postoperative Stem Cell Mobilization on Bone
Formation and Interbody Fusion in an Ovine Model
Jonathon Geisinger, MD; Richard Roberts, MD; Chad Jones, MD; Abby Davidson, MS;
Meagan Salisbury, MS; Tristan Maerz, Ph.D.; Daniel Park, MD; Jeffrey Fischgrund, MD;
Kevin Baker, PhD
Poster #14 Preoperative Obesity Class III Designation as a Risk Factor for Major Postoperative
Complications after Anterior Lumbar Fusion
Chierika Ukogu, BA; Samantha Jacobs, BA; William Ranson, BS; Sulaiman Somani, BS;
Jun Kim, MD; John Di Capua, MHS, BS; Awais Hussain, B.A.; Samuel Cho, MD
Poster #15 The Utility of In-hospital Postoperative Radiographs Following Surgical Treatment of
Traumatic Thoracolumbar Injuries
Joseph Pyun, MD; Tristan Weir, BS; Daniel Gelb, MD; Steven Ludwig, MD; Eugene Koh,
MD, PhD; Kelley Banagan, MD; Luke Brown, MD
Poster #16 How Does Case Type, Length of Stay, and Comorbidities Affect Medicare DRG
Reimbursement for Minimally Invasive Surgery (MIS) for Deformity?
Pierce Nunley, MD; Richard Fessler, MD, PhD; Gregory Mundis, MD; Robert Eastlack,
MD; Dean Chou, MD; Christopher Shaffrey, MD; Praveen Mummaneni, MD; International
Spine Study Group (ISSG)
Poster #17 Do Former Smokers Exhibit a Distinct Profile Before and After Lumbar Spine Surgery?
Ehsan Jazini, MD; Leah Carreon, MD; Steven Glassman, MD
Poster #18 Can Liposomal Bupivacaine Be Safely Utilized in Patients Undergoing Spine Surgery?
Luke Brown, MD; Mark Shasti, MD; Julio Juaregui, MD; Steven Ludwig, MD; Daniel Gelb,
MD; Eugene Koh, MD, PhD; Kelley Banagan, MD
Poster #19 A Comparison of Anterior and Posterior Lumbar Interbody Fusions– Complications,
Readmissions, Discharge Dispositions and Costs
Rabia Quereshi, BS; Varun Puvanesarajah, BS; Amit Jain, MD; Adam Shimer, MD; Francis
Shen, MD; Hamid Hassanzadeh, MD
Poster #20 Postoperative Complications in Orthopaedic Spine Surgery- Is There a Difference
Between Males and Females?
Jessica Heyer, MD; Na Cao, BS, MS; Raj Rao, MD
Poster #21 Operative Approaches for Lumbar Disc Herniation: A systematic review and multiple
treatment meta-analysis of conventional and minimally invasive surgeries.
Mohammed Ali Alvi, MD; Daniel Shepherd, MD; Jang Yoon, MD; Panagiotis Kerezoudis,
MD; Mohamad Bydon, MD
Poster #22 Comorbid Conditions as Predictors of Postoperative Outcome Following Lumbar Spine
Surgery: a Survey of United States Orthopaedic and Neurological Surgeons
Heath Gould, BS; Jeffrey O'Donnell, BS; Vince Alentado, MD; Colin Haines, MD; Jason
Savage, MD; Thomas Mroz, MD;

28

Poster #23 High Risk Subgroup Membership as a Risk Factor for Post-Operative Complications
after Posterior Lumbar Fusion
Jun Kim, MD; John Di Capua, MHS, BS; Sulaiman Somani, BS; Rachel Bronheim, BA;
Nathan Lee, BS; Parth Kothari, BS; Deepak Kaji, BS; Samuel Cho, MD
Poster #24 Impact of sarcopenia on outcomes following elective lumbar fusion
Doniel Drazin, MD, MA; Christopher Kong, MD; Miriam Treggiari, MD; Robert Hart, MD
Poster #25 The Impact of Sciatica on United States Medicare Recipients
Tyler Jenkins, MD; Joseph Maslak, MD; Daneel Patoli, BS; Wellington Hsu, MD; Alpesh
Patel, MD, FACS
Poster #26 Anemia as a Risk Factor for 30-Day Postoperative Complications Following Elective
Anterior Lumbar Fusion Surgery
William Ranson, BS; Chierika Ukogu, BA; Samantha Jacobs, BA; John Di Capua, MHS, BS;
Sulaiman Somani, BS; Jun Kim, MD; Yi Hong Zheng, BA, Molecular and Cell Biology;
Samuel Cho, MD
Poster #27 Assessment of Demographic, Preoperative, and Intraoperative Risk Factors for Cardiac
Arrest Following Elective Posterior Lumbar Fusion Surgery
Sulaiman Somani, BS; Jun Kim, MD; John Di Capua, MHS, BS; Samantha Jacobs, BA;
Chierika Ukogu, BA; William Ranson, BS; Chuma Nwachukwu, BA; Samuel Cho, MD
Poster #28 Metabolic Syndrome is Associated with Increased Wound Complications and Urinary
Tract Infections after Lumbar Fusion: a Propensity Score-Matched Analysis
Francis Lovecchio, MD; Michael Fu, MD; Sravisht Iyer, MD; Todd Albert, MD
Poster #29 Safety and Outcomes Following Anterior versus Posterior Lumbar Interbody Fusion
Procedures
Jamal Shillingford, MD; Joseph Laratta, MD; Joseph Lombardi, MD; John Mueller, BS;
Charla Fischer, MD; Ronald Lehman, MD
Poster #30 Association between Allogeneic Blood Transfusion and Postoperative Infection in
Major Spine Surgery
Christian Fisahn, Shiveindra Jeyamohan, MD; Daniel Norvell, PhD; R. Tubbs, PhD; Marc
Moisi, MD; Jens Chapman, MD; Jeni Page, ACNP-BC; Rod Oskouian, MD
Poster #31 Predictors of Complications and Readmission following Spinal Stereotactic
Radiosurgery
Daniel Lubelski, MD; Joseph Tanenbaum, BS; Taylor Purvis, BS; Thomas Bomberger, BA;
C. Rory Goodwin, MD/PhD; Daniel Sciubba, MD
Poster #32 Evaluating the Effect of Growing Patient Numbers and Changing Data Elements in the
National Surgical Quality Improvement Program (NSQIP) Database Over the Years: A
Study of Lumbar Fusions
Blake Shultz, BA; Patawut Bovonratwet, BS; Nathaniel Ondeck, BS; Taylor Ottesen, BS;
Ryan McLynn, BS; Jonathan Cui, BS; Jonathan Grauer, MD
Poster #33 Total Disc Arthroplasty and Anterior Interbody Fusion in the Lumbar Spine Have
Relatively Similar Short-Term Outcomes
Blake Shultz, BA; Alexander Wilson, BS; Nathaniel Ondeck, BS; Patawut Bovonratwet,
BS; Ryan McLynn, BS; Jonathan Cui, BS; Jonathan Grauer, MD
29

Poster #34 Trends in Resource Utilization for Vertebral Fracture Repair Surgeries in the United
States from 2006-2014
Alejandro Cazzulino, BA; Comron Saifi, MD; Melvin Makhni, MD; Matthew Colman, MD;
Christopher Dewald, MD; Ronald Lehman, MD; Howard An, MD; Frank Phillips, MD
Poster #35 Age as a Risk Factor for 30-Day Postoperative Complications Following Anterior
Lumbar Fusion
Chierika Ukogu, BA; William Ranson, BS; Samantha Jacobs, BA; John Di Capua, MHS, BS;
Sulaiman Somani, BS; Jun Kim, MD; Rachel Bronheim, BA
Poster #36 Differences in reported experience with hospital care in patients undergoing cranial
and spinal operations
Panagiotis Kerezoudis, MD; Elizabeth Habermann, PhD; Mohammed Ali Alvi, MD; Jang
Yoon, MD; Daniel Ubl, BA; Kristine Hanson, MPH; Mohamad Bydon, MD
Poster #37 The Decussating Fibers of the Lumbar Thoracolumbar Fascia: A Landmark for
Identifying the L5 Spinous Process?
Fernando Alonso, MD; Doniel Drazin, MD, MA; Tarush Rustagi, MD; Rod Oskouian, MD;
Jens Chapman, MD; R. Tubbs, PhD
Poster #38 Predictors of Major Complications Following Anterior Lumbar Fusion
Samantha Jacobs, BA; William Ranson, BS; Chierika Ukogu, BA; Jun Kim, MD; John Di
Capua, MHS, BS; Sulaiman Somani, BS; Robert Merrill, BS; Samuel Cho, MD
Poster #39 Correlation Between the Modic Changes and Facet Osteoarthritis in Lumbar Spine
Permsak Paholpak, MD; Emin Dedeogullari; Koji Tamai, MD; Kaku Barkoh, MD; Kittipong
Sessumpun, MD; Jeffrey Wang, MD; Zorica Buser, PhD
Poster #40 Continued Inpatient Care After Posterior Lumbar Fusion Is Associated With Increased
Post-Discharge Complications: A Propensity-Adjusted Analysis
Andre Samuel, BBA; Michael Fu, MD; William Schairer, MD; Peter Derman, MD;
Alexander McLawhorn, MD; Todd Albert, MD

30

FOUNDED 2008

PAPER ABSTRACTS

DISCLAIMER

Some drugs or medical devices demonstrated at this course may not have been cleared by the FDA or
have been cleared by the FDA for specific purposes only. The FDA has stated that it is the responsibility
of the physician to determine the FDA clearance status of each drug or medical device he or she wishes
to use in clinical practice.
Academy policy provides that “off label” uses of a drug or medical device may be described in the
Academy’s CME activities so long as the “off label” use of the drug or medical device is also specifically
disclosed (i.e., it must be disclosed that the FDA has not cleared the drug or device for the described
purpose). Any drug or medical device is being used “off label” if the described use is not set forth on
the product’s approval label.

• Indicates those faculty presentations in which the FDA has not cleared the drug and/or medical
device for the use described (i.e., the drug or medical device is being discussed for an “off label”
use).
31
Paper 01

Efficacy and Safety of High-dose Tranexamic Acid Protocol in Adult Spinal Deformity – Analysis of
100 Consecutive Cases

James Lin, MD, MS1, Jamal Shillingford, MD2; Joseph Laratta, MD2, Lee Tan, MD1, Charla Fischer,
MD3, Ronald Lehman, MD4, Lawrence Lenke, MD2
1
Columbia University Medical Center, New York, NY, 2, New York, NY, 3Columbia University
Department of Orthopaedic Surgery, New York City, New York, 4, New York, NY

Background/Introduction: Adult spinal deformity (ASD) surgery is a massive undertaking that may
involve a significant amount of blood loss, especially when various osteotomy techniques are
utilized. Antifibrinolytic agents such as tranexamic acid (TXA) have been used in an attempt to
reduce intraoperative blood loss. However, there is no universally accepted dosing protocol for TXA
in spine surgery. Moreover, there are very few reports in the literature regarding high-dose TXA
use in ASD, possibly due to concerns for thromboembolic or seizure risks. This study aims to
investigate the safety profile and efficacy of using a high-dose (50mg/kg loading, 5mg/kg/hr
infusion) TXA protocol during ASD surgery.

Materials/Methods: Consecutive patients undergoing spinal deformity correction over a 14-month
period (September 1st 2015 – November 1st 2016) at a single institution were identified. Inclusion
criteria were adults (age >= 18 years) who underwent posterior spinal fusion surgery of at least 5
levels. Our standard TXA protocol is 50 mg/kg intravenous loading dose followed by a 5 mg/kg/hr
infusion until skin closure. Patient demographics, estimated blood time (EBL), post operative blood
transfusion, and other procedure specific information were recorded and analyzed.

Results: A total of 100 adult patients were included in the study. Operative procedures were
performed by a single surgeon. The mean age was 46.5 years, and 71% of patients were female.
Average BMI was 24.7. The average fusion length was 14 levels. 46/100 patients had a primary
surgical procedure while the rest were revisions. 61/100 of patients had pelvic fixation. Posterior
column osteotomies were performed on 80/100 patients; pedicle subtraction osteotomy (PSO) was
performed in 8 patients; and vertebral column resections (VCRs) were performed in 15 patients.
Mean intraoperative blood loss among all patients was 1296cc. There was one PE was treated with
a heparin drip, and two DVTs which developed in rehab which were treated with oral
anticoagulation. There were no MIs, seizures, strokes, or renal complications.

Discussion/Conclusion: This study demonstrates that high dose TXA is effective and safe to use in
well-selected ASD patients and lays the foundation for further studies on this important topic.

32

33
Paper 02

Comparison of Bleeding vs Clotting Complications after Lumbar Spine Surgery

Haroutioun Boyajian, MD1, Olumuyiwa Idowu, BA2, William Mosenthal, MD1, Lewis Shi, MD1,
Michael Lee, M.D.3
1
, Chicago, IL, 2, Chicago, Illinois, 3University of Chicago Medical Center, Chicago, IL

Background/Introduction: Unlike almost all other inpatient surgery, chemical anticoagulation after
spine surgery is frequently withheld due to fear of bleeding complications. Unlike most other
surgeries, bleeding complications after spine surgery can result in neurological injury. The purpose
of this study was to compare the incidence of bleeding and clotting complications in patients who
have undergone spinal surgery without postoperative anti-coagulation, using a large national
database.

Materials/Methods: A retrospective review of the Truven Health Marketscan® Research Databases
was conducted for patients undergoing lumbar spine operations between 2003 and 2014. Patients
were divided into 3 groups: anterior lumbar surgery, posterior lumbar fusion, and posterior lumbar
laminectomy. The ICD-9-CM diagnosis codes for epidural hematoma, hematoma, seroma, deep
vein thrombosis (DVT), and pulmonary embolism (PE) were used to calculate the incidence of these
complications within three months of surgery in each group. The rate of operative intervention for
the bleeding complications was assessed and compared to the rate of PE. The relative risks of these
complications were calculated for surgical approach and fusion vs. decompression.

Results: 379,871 patients were included in the study. Overall, 8,609 (2.3%) patients developed
bleeding complications (seroma+hematoma+epidural hematoma) while 13,384 (3.5%) developed
clotting complications (DVT + PE). 1222 (.32%) patients underwent surgical drainage for their
bleeding complication, and 1,216 (0.32%) patients developed PE. While the rates of all bleeding
complications were comparable to the rates of all thrombosis complications in all subgroups, the
rate of PE was 5-7 fold higher than the rate of bleeding complication requiring operative
intervention in all sub groups (p<0.001) (Table 1) We observed a significantly higher risk of bleeding
and thrombotic complications in posterior lumbar fusion as compared to anterior fusion (RR 1.43,
1.81 respectively). We also observed a significantly higher risk of bleeding and thrombotic
complications in posterior lumbar fusion as compared to posterior decompression alone ((RR 1.51,
1.48 respectively).

Discussion/Conclusion: We observed that PE rates were 5-7 fold higher than rates of bleeding
complications requiring surgery. Given this large disparity in these complication rates, it may be
worthwhile considering routine chemical anticoagulation after spine surgery.

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Paper 03

Pharmacologic Prophylaxis for Venous Thromboembolism in Elective Spine Surgery

Ryan McLynn, B.S.1, Patawut Bovonratwet, BS2, Nathaniel Ondeck, B.S.3, Jonathan Cui, B.S.1, Taylor
Ottesen, B.S.4, Blake Shultz, B.A.1, Jonathan Grauer, MD3
1
Yale School of Medicine, New Haven, Connecticut, 2Yale School of Medicine, New Haven, CT, 3,
New Haven, CT, 4Yale University School of Medicine, New Haven, CT

Background/Introduction: Venous thromboembolism (VTE) is a known complication after spine
surgery, but data and guidelines for prophylaxis are unclear for patients undergoing elective spine
surgery. The current study examines VTE incidence, risk factors, and association of pharmacologic
prophylaxis with VTE and postoperative hematoma in elective spine surgery patients.

Materials/Methods: Patients who underwent elective spine surgery, 2013-2016, were identified at
a large academic medical center. A chart review was completed to examine for use of
pharmacologic prophylaxis for VTE, history of prior VTE, and incidence of hematoma requiring
reoperation. Additional demographic, comorbidity, intraoperative, and postoperative factors were
available for each patient. The association of demographic, comorbidity, intraoperative, and
postoperative factors, including history of prior VTE and pharmacologic prophylaxis status, with
VTE and postoperative hematoma requiring reoperation were tested with multivariate regression.

Results: The study included 2,855 patients. Pharmacologic prophylaxis was received by 56.3% of
patients, and unfractionated heparin was the most frequently used agent (96.8%). The incidence of
postoperative VTE was 1.23% (35/2,855), and independent risk factors for VTE included increasing
age, male gender, higher BMI, perioperative blood transfusion, urinary tract infection, longer
length of stay, and history of prior VTE. Pharmacologic prophylaxis did not significantly influence
the rate of VTE (RR=0.68, P=0.424), even after controlling for patient risk factors and prescribing
patterns. The incidence of postoperative hematoma requiring return to the operating room was
0.4% (11/2,855). Seven of the postoperative hematomas presented with significant neurological
deficits (63.6%), three presented with pain or wound drainage (27.3%), and one presented with
respiratory compromise (9.1%). Among 10 patients experiencing hematoma who received
prophylaxis, nine received unfractionated heparin and one received enoxaparin. Pharmacologic
prophylaxis was associated with significant increase in postoperative hematoma requiring return to
operating room (RR=7.37, P=0.048).

Discussion/Conclusion: Contrary to expected findings, pharmacologic prophylaxis for VTE after
elective spine surgery was not associated with a significant reduction in VTE that we could detect.
Further, there was a significant increase in postoperative hematoma requiring reoperation among
patients receiving prophylaxis, leading to questions about routine use of pharmacologic VTE
prophylaxis for elective spine surgery.

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Paper 04

Fever Following Lumbar Fusion Procedures

Fady Hijji, BS1, Ankur Narain, BA1, Daniel Bohl, MD, MPH2, Benjamin Mayo, BA3, Dustin Massel, BS3,
Krishna Kudaravalli, BS1, Kelly Yom, BA1, Kern Singh, MD3
1
, Chicago, IL, 2Rush University Medical Center, New Haven, CT, 3Rush University Medical Center,
Chicago, IL

Background/Introduction: Postoperative fever is a common occurrence following lumbar fusion
surgery. While a postoperative fever can indicate underlying complications such as infection, it is
often self-limited with no definitive cause. However, patients who develop transient postoperative
fevers often undergo extensive workups, unnecessarily increasing costs and patient anxiety. In this
context, this study aims to describe the incidence and timing of postoperative fever, the outcomes
of fever workups, and the risk factors associated with fevers following lumbar fusion.

Materials/Methods: A retrospective review of a prospectively collected registry of patients
undergoing transforaminal, posterior, anterior, or lateral lumbar fusion for degenerative disease
was performed. For patients in whom postoperative fever (≥101.5 F) was documented, charts were
reviewed for any fever workup or diagnosis. Additionally, multivariate regression was used to
identify independent risk factors for the development of postoperative fever.

Results: 891 patients undergoing lumbar fusion met inclusion criteria, of which 107 (12.0%)
exhibited at least one fever during their hospital course. Of these, 64 had only one fever, 15 had
two fevers, and 28 had 3 or more fevers. 43.9% of first-documented fevers occurred during the first
24 hours, 53.3% during postoperative hours 24-48, and 2.8% following 48 hours. At least one
component of a fever workup was conducted in 49 of the 107 patients who had fever (45.8%),
resulting in fever-associated diagnoses in 4 patients prior to discharge. Additionally, 3 patients with
fevers during the inpatient stay developed complications after discharge. On multivariate analysis,
operations longer than 150 minutes (relative risk [RR]=1.66, p=0.015) and narcotic consumption
greater than 85 oral morphine equivalents on postoperative day 0 (RR=1.69, p=0.015) were
independently associated with increased risk of developing postoperative fever.

Discussion/Conclusion: The results of this study suggest that inpatient fever occurs in about 1 in 8
patients following lumbar fusion surgery. In most cases for which a fever workup is performed, no
cause for fever is detected. Longer operative time and increased early postoperative narcotic use
may increase the risk of developing postoperative fever. Fever workups following lumbar fusion are
probably most effective when pursued with the guidance of an associated postoperative symptom
suggesting a potential source.

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39
Paper 05

Betadine Irrigation and Intrawound Vancomyin Powder Prevent Wound Complications Following
Lumbosacral Tumor Surgery.

Addisu Mesfin, MD
University of Rochester, Rochester, NY

Background/Introduction: Surgical management of metastatic and primary spine tumors is
associated with wound complication (infection, dehiscence) rates of up to 30%. The role of
concurrent intrawound vancomycin powder (IVP) and betadine irrigation (BI) has not been
examined in spine tumor surgery. Our objective was to evaluate wound complications following
administration of IVP and BI for lumbar and sacral tumor surgery.

Materials/Methods: Patients undergoing spine tumor surgery by one surgeon at a regional cancer
referral center from November 2012 to December 2016 were identified. Inclusion criteria were
lumbar or sacral tumor surgery, minimum 30 days follow-up, administration of 1 to 2gm of IVP
during wound closure and BI throughout the case. Demographic information (age, sex,
race/ethnicity), location (lumbar, sacrum), histology (primary/metastatic), neurological status on
presentation (ASIA motor scale), surgical data (EBL, instrumentation, approach), wound
complications and radiation treatment status (pre and post-operative) were collected.

Results: 21 patients undergoing 23 procedures for lumbar and sacral tumors were enrolled. There
were 8 females and 13 males with an average age of 55.1 (9 – 92) with 19 Caucasians, 1 African-
American and 1 Native-American. 17 lesions were in the lumbar spine and 4 in the sacrum.
Histology included 5 primary tumors (Chordoma 1, Angiolipoma 1, Aneurysmal bone cysts 3) and 16
metastatic tumors (Lung 7, Melanoma 2, Breast 1, Renal 1, Colon 1, Lymphoma 1, Hepatoid 1,
Prostate 1, Squamous cell CA 1). Neurological status was 7 ASIA D and 14 ASIA E. Average EBL was
651ml (100 – 2500), with 19 posterior only and 2 anterior-posterior approaches. All patients had a
decompression, 6 had a transpedicular decompression and 1 patient with chordoma underwent an
en-bloc spondylectomy. 15 of 21 patients had instrumentation (average of 3 levels [3-6]). 3 had
pre-operative radiation only and 12 had post-operative radiation only. There was a 0% rate of
wound complications. 33% were deceased at latest follow-up.

Discussion/Conclusion: Intrawound vancomycin powder and betadine irrigation resulted in a 0%
rate of wound complications in patients with lumbar and sacral spine tumors. IVP and BI are
inexpensive modalities that can minimize the risk of wound complication in high -risk spine tumor
patients.
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41
Paper 06

Outcomes of Suprafascial Vacuum Assisted Closure Device in Spine Surgical Site Infections
Management

Swamy Kurra, MBBS, Richard Tallarico, MD; Mike Sun, MD, William Lavelle, MD
, Syracuse, NY

Background/Introduction: Many studies reported benefits using negative pressure wound therapy
(NPWT) in surgical site infections (SSIs). Surgeons utilize NPWT in different ways. Some surgeons
place the VAC (vacuum assisted closure) sponge into the open wound bed and allow the device to
facilitate tissue granulation until ultimate closure (Open VAC). Others believe a bed of muscle is
beneficial and re-approximate the patient’s paraspinal muscles and place the VAC device over the
re-approximated muscle (Closed VAC). We compared the outcomes between open VAC and closed
VAC procedures used in the management of SSIs occurring after spinal deformity surgeries.

Materials/Methods: This retrospective study included 23 consecutive patients (males-9, females-
14) with an average age of 60 years with SSIs managed with NPWT following spinal procedures
between 2012 and 2015. All patients received IV preoperative empirical antibiotics except two
patients who received antibiotics after cultures were taken. Once growth cultures revealed the
causative organisms, patients were placed on appropriate antibiotic therapy for at least 4 -6 weeks.
A total of 33 wound VAC procedures in 23 patients were separated into two groups based on the
type of wound closure: Group 1 (n=12, Open VAC) and Group 2 (n=21, Closed VAC). Complications
after wound closure, duration of wound vac therapy (days) and re-operation rates were compared
between groups. Statistical analysis was made using ANOVA and Chi Square tests for continuous
variables. P≤0.05 was considered statistically significant.

Results: The re-operation rate was 63% in Group 1 and 19% in Group 2 during VAC therapy for
persisted infections. Mean duration of wound VAC therapy was 77 days in Group 1 and 33 days in
Group 2 (Table 1). In Group 2, one patient had re-infection after complete eradication of the initial
infection and none were noticed in Group 1.

Discussion/Conclusion: Our study compared the outcomes between two techniques of placing a
wound VAC in SSIs. The mean therapy duration and re-operative surgeries were less in closed
wound VAC therapy. The small sample size was a limitation of the study. Management of spine SSIs
with re-approximated suprafascial wound VAC reduces re-operation rates and duration of wound
VAC therapy.

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43
Paper 07

Can a surgeon’s demographic factors predict postoperative complication rates after an elective
spinal fusion?

Gurmit Singh, BS1, Danielle Chun, MD2, Ralph Cook, BS2, Joseph Weiner, BS3, Michael Schallmo, BS3,
Kathryn Barth, BS2, Sameer Singh, BS2, Ryan Freshman, BS2, Alpesh Patel, MD, FACS4, Wellington
Hsu, M.D.5
1
, Chicago, IL, 2Northwestern University Department of Orthopaedic Surgery, Chicago, IL,
3
Northwestern University Department of Orthopaedic Surgery, Chicago , IL, 4Northwestern
University, Chicago, IL, 5Northwestern Memorial Hospital, Chicago, Illinois

Background/Introduction: A surgeon’s demographic factors have been shown to impact surgical
decision-making in the management of degenerative disease of the lumbar spine. Complication
rates are frequently reported outcome measurements that are used as quality-of-care indicators
for surgical treatments. Thus, complication rates are used by healthcare systems to assess
payments and reimbursements. However, there are few studies investigating the association
between surgeons’ demographic factors and complication rates. The purpose of this study was to
determine whether surgeons’ demographic factors – surgical specialty, years in practice, type of
practice, medical degree earned, location of medical school, gender, and geographic region of
practice – influence postoperative complication rates for elective spine fusion procedures.

Materials/Methods: A database of U.S. spine surgeons with corresponding postoperative
complications data after elective lumbar (posterior approach) spine fusion was compiled utilizing
publicly available data from the Centers for Medicare and Medicaid Services (CMS) from 2011-2013
and ProPublica Surgeon Scorecard from 2009-2013. Demographic data for each surgeon was
manually collected, including surgical specialty (orthopaedic vs. neurological surgeons), years in
practice, practice setting (private vs. academic), medical degree (M.D. vs. D.O.), medical school
location (U.S. vs. foreign), gender, and geographic region of practice. General linear mixed models
using a Beta distribution with a logit link and pairwise comparison with post-hoc Tukey-Kramer
were used to assess the relationship between surgeons’ demographics and complication rates.

Results: 2,110 U.S. spine surgeons who performed spine fusions on 125,787 Medicare patients
from 2011-2013 met the inclusion criteria. None of the surgeons’ demographic factors analyzed
were found to significantly affect the overall complication rates in lumbar (posterior approach)
spine fusion (Table 1).

Discussion/Conclusion: Complication rates for an individual spine surgeon are being utilized by
hospital systems and patients to assess the surgeon’s aptitude and gauge expectations. The
increasing demands for transparency will likely lead to an emphasis on these statistics and any
measures instituted to improve outcomes. We conclude that none of the surgeons’ demographic
factors analyzed in this study are associated with the differences in the overall complications rates
in patients undergoing elective spine fusion.

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45
Paper 08

Adverse Events following Posterior Lumbar Fusion: A Comparison of Spine Surgeons Perceptions
at LSRS and Reported Data for Rates and Risk Factors

Nathaniel Ondeck, B.S.1, Daniel Bohl, MD, MPH2, Patawut Bovonratwet, BS3, Ryan McLynn, B.S.4,
Jonathan Cui, B.S.4, Andre Samuel, BBA3, Matthew Webb, AB3, Jonathan Grauer, MD1
1
, New Haven, CT, 2Rush University Medical Center, New Haven, CT, 3Yale School of Medicine,
New Haven, CT, 4Yale School of Medicine, New Haven, Connecticut

Background/Introduction: Post-operative complications and risks factors for adverse events play
an important role in both decision-making and patient expectation setting. No recent study has
examined the relationship between surgeons perceived understanding of these characteristics and
nationally reported data. In this context, the purpose of the present study is to contrast surgeons’
perceived and reported rates of post-operative adverse events following posterior lumbar fusion
(PLF) and to assess the accuracy of predicting the impact of patient factors on such outcomes.

Materials/Methods: A survey investigating perceived rates of adverse events and the impact of
patient risk factors on the occurrence of adverse events following PLF for degenerative conditions
was distributed to spine surgeons at the Lumbar Spine Research Society (LSRS) 2016 annual
meeting. For comparison, the corresponding rates and patient risk factors were assessed in
patients undergoing elective PLF from the American College of Surgeons National Surgical Quality
Improvement Program (NSQIP) data years 2011-2014.

Results: From the survey, there were 53 responses (response rate of 82%) from attending
physicians at LSRS. From NSQIP, there were 16,589 patients who met the inclusion criteria. Adverse
event rates estimated by the surgeons at LSRS were close to those determined by NSQIP data (no
greater than 2.81% different, Figure 1). Surgeons overestimated the rate of 13 out of 17 (76%)
post-operative adverse events by 0.17% to 2.81%. The largest differences were for deep vein
thrombosis (overestimation of 2.81%, P < 0.001), anemia requiring transfusion (overestimation of
2.47%, P = 0.018), and urinary tract infection (overestimation of 2.29%, P < 0.001). Similarly, the
estimated impact of patient factors was similar to the data (within relative risk of 2.02). The largest
differences were for current smoking (overestimation of 2.02 relative risk, P < 0.001), insulin
dependent diabetes (overestimation of 1.36, P < 0.001), and obesity (overestimation of 1.35, P <
0.001).

Discussion/Conclusion: The current study noted that surgeon estimates were relatively close to
national numbers for estimating the adverse events and impact of patient factors on such
outcomes after PLF for degenerative conditions. The estimates are roughly appropriate with a bias
toward overestimation for planning and expectation setting.

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47
Paper 09

Rates of Mortality Among Lumbar Spine Surgical Procedures and Factors Associated with its
Occurrence Over a Ten Year Period: A Study of 803,949 Patients on the Nationwide Inpatient
Sample

Gregory Poorman, BA1, John Moon, BS2, Samantha Horn, BA3, Olivia Bono, BA3, Anna-Marie Francis,
BA3, Cyrus Jalai, BA3; Michael Gerling, MD1; Peter Passias, MD3
Hospital for Special Surgery, New York, NY1, bronxville, ny, 2, New york, ny, 3, New York, NY

Background/Introduction: Risk of death is important in counseling patients and improving quality
of care. Incidence of death in lumbar surgery is not firmly established due to its rarity and limited
sample sizes, particularly in the context of different surgeries, demographics, and risk factors.
Particularly, different patient risk profiles may have varying degrees of risk in terms of surgeries,
comorbidities, and demographics. This study aims to use a large patient cohort available on a
national database in order to study the prevalence of death associated with lumbar spine surgery.

Materials/Methods: The Nationwide Inpatient Sample (NIS) database was reviewed from 2003-
2012. 803,949 patients ages 18 years or older were identified by ICD-9CM procedure codes for
spinal fusion or decompression of the lumbar spine. Incidence of mortality was assessed by chi-
squared tests across different patient demographics and comorbidities, procedures performed, and
concurrent in-hospital complications. Binary logistic regression identified significant increases or
decreases in risk of death while controlling for comorbidities, BMI, race, sex, and Mirza
invasiveness. Significance was defined as p<0.05 differences relative to overall cohort

Results: Mortality for all patients requiring surgery of the lumbar spine was 0.13%. Mortality based
on procedure type was 0.105% for simple fusions, 0.321% with complex fusions, and 0.081% for
decompression only. Increased mortality was observed demographically in patients who were male
(OR: 1.75 (95% CI: 1.51-2.03)), black race (OR: 1.40 (CI: 1.10-1.79), and in the 65-74 (OR: 1.46 (CI:
1.25-1.70)) and 75+ age cohorts (OR: 2.70 (CI: 2.30-3.17)). Comorbidities associated with the
greatest increase in mortality were mild (OR: 10.04 (CI: 7.76-13.01)) and severe (OR: 26.47 (CI:
16.03-43.70)) liver disease, and congestive heart failure (CHF; OR: 4.57 (CI: 3.77-5.53)). The
complications with the highest mortality rates were shock (OR: 20.67 (CI: 13.89-30.56)) and
pulmonary embolism (OR: 20.15 (CI: 14.01-29.00)).

Discussion/Conclusion: Rates and causes of mortality in adult patients undergoing different
surgeries of the lumbar spine can be helpful to surgeons providing pre-operative counseling and for
allocating resources to treat and prevent perioperative complications leading to mortality.
Particularly concerning mortality rates of 1.42% in 16,693 patients with comorbid CHF, and 1.91%
in 5,183 patients with mild liver disease.

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Paper 10

Inaccuracies in ICD Coding for Obesity Bias Toward Higher Frequency of Coding in Patients with
Increased Comorbidities and Correlate with Postoperative Complications: A Limitation for Spine
Studies Using Administrative Databases

Ryan McLynn, B.S.1, Benjamin Geddes, MD2, Jonathan Cui, B.S.1, Nathaniel Ondeck, B.S.3, Patawut
Bovonratwet, BS2, Blake Shultz, B.A.1, Jonathan Grauer, MD3
1
New Haven, CT

Background/Introduction: There has been increased use of national databases in the spine surgery
literature, much of which relies on International Classification of Diseases (ICD) codes. Past
research has demonstrated that the sensitivity of ICD-9 codes for obesity is poor. However, it
remains unclear whether coding inaccuracies are biased toward certain patient subgroups and how
potential bias may influence the outcomes of database research.

Materials/Methods: Patients who underwent elective posterior lumbar fusion from 2013-2016 at a
large academic hospital were identified. All ICD-9 and ICD-10 codes assigned to the encounter were
obtained. Height and weight at the time of surgery were measured, body mass index (BMI) was
calculated, and other demographic, comorbidity, intraoperative, and postoperative factors were
available for each patient. With the gold standard considered BMI≥30 kg/m2 for obesity and
BMI≥40 kg/m2 for morbid obesity, the sensitivity of ICD coding for obesity and morbid obesity was
calculated. Sensitivity was compared for subgroups defined by demographic, comorbidity,
intraoperative, and postoperative variables (e.g. smokers versus nonsmokers). The association of
obesity with various adverse events was tested using multivariate regression, controlling for age
and American Society of Anesthesiologists (ASA) class.

Results: The study included 796 patients. Based upon calculated BMI, 50.25% of patients were
obese (N=400), including 7.0% who were morbidly obese (N=56). The sensitivity of ICD coding for
obesity was 42.5% and for morbid obesity was 60.7%. The sensitivity of ICD coding was significantly
higher in patients with greater BMI, diabetes, ASA class ≥ III, increased length of stay, venous
thromboembolism (VTE), a major adverse event, and any adverse event. In the multivariate
analysis, assignment of obesity ICD coding was significantly associated with VTE, major adverse
events, and any adverse event; however there were no associations when obesity was defined by
calculated BMI.

Discussion/Conclusion: ICD codes for obesity have poor sensitivity and are applied significantly
more often to patients with other comorbidities or postoperative complications. Obesity was
associated with more postoperative complications when defined by ICD codes than by calculated
BMI. Obesity coding in administrative databases may be skewed toward more complex patients,
which may bias studies to overestimate the impact of obesity on adverse outcomes.

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Paper 11

Is There Value in Retrospective 90-day Bundle Payment Models for Lumbar Spine Fusion
Procedures?

Susan Odum, PhD1, Bryce Van Doren, MPA, MPH2, Leo Spector, MD3
1
OrthoCarolina Research Institute, Charlotte, NC, 2OrthoCarolina Research Institute, Charlotte,
North Carolina, 3OrthoCarolina, Charlotte, NC

Background/Introduction: At our private practice, we implemented a Centers for Medicaid and
Medicare Services (CMS) Bundled Payments for Care Improvement (BPCI) initiative retrospective
payment model 2 in 2015 for a 90-day episode of care for lumbar fusions and other procedures.
Under this model, CMS continues to make fee-for-service payments but reconciles total
expenditures for the episode with a bundled payment reflecting the aggregate expenditures
compared to the target price. The purpose of the study is to assess the value of the lumbar spine
CMS bundle at our private practice.

Materials/Methods: We utilized data provided by CMS to compare the total expenditures of
lumbar fusion DRGs 453-460. Medicare patients undergoing lumbar fusion surgery between
January 2009-December 2012 were defined as non-BPCI (n=303) and compared to Medicare BPCI
patients (n=200) undergoing surgery between January-December 2015. Post-acute events within
the 90 day episode, including admission to an IRF or SNF, home health (HH), and readmission, were
analyzed. Expenditures were converted to 2016 dollars and compared using bivariate and
multivariate methods.

Results: The median expenditure for FFS and BPCI patients was $24,782 (IQR $24,088-$25,542) and
$24,113 (IQR $23,634-$24,978; p<0.01), respectively. Compared to FFS patients, BPCI patients had
a higher rate of SNF admissions (FFS 29.72% vs 38.46% BPCI; p=0.36) and HH (FFS 41.18% vs 53.67%
BPCI; p<0.01). IRF admissions were lower for BPCI patients (FFS 4.64% vs 1.69% BPCI; p=0.13) as
well as readmissions (FFS 14.24% vs 9.60% BPCI; p=0.16). At the multivariate level, there was no
significant difference in total post-acute expenditures between patient groups (p=0.87), but all
post-acute events were significant, independent drivers of increased cost. Admissions to an IRF,
SNF, HH utilization, and 90-day readmissions increased cost 45% (p<.0001), 28% (p<.0001), 10%
(p<.0001), and 43% (p<.0001), respectively.

Discussion/Conclusion: In spite of our best efforts to contain costs with practice guidelines, patient
navigators, and a BPCI management team, expenditures were slightly higher for BPCI lumbar
patients. With the low frequency and high variability of surgical complexity of these procedures,
lumbar fusion bundles are challenging to manage. We discontinued our spine BPCI, but applied our
lessons learned to other consumer bundles to include specific CPT codes.

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Paper 12

Incidence of 90 Day Readmissions Following Posterior Lumbar Fusion

Jonathan Cui, B.S.1, Raj Gala, MD1, Nathaniel Ondeck, B.S.2, Ryan McLynn, B.S.1, Patawut Bovonratwet, BS3,
Blake Shultz, B.A.1, Jonathan Grauer, MD2
1
Yale School of Medicine, New Haven, Connecticut, 2, New Haven, CT, 3Yale School of Medicine, New
Haven, CT

Background/Introduction: Posterior lumbar fusion (PLF) is a commonly performed procedure. The evolution
of bundled payment plans is beginning to require physicians to more closely consider patient outcomes for
up to 90 days after an operation. Although the commonly used American College of Surgeons National
Quality Improvement Program (ACS-NSQIP) database tracks readmissions for 30 postoperative days, it is
difficult to know if readmissions have plateaued at the end of that tracking. The relatively new Healthcare
Cost and Utilization Project National Readmissions Database (HCUP-NRD) database tracks patient linked
hospital admissions data for up to a year.

Materials/Methods: PLFs performed in the first 9 months of 2013 were identified in the HCUP-NRD. Patient
demographics and readmissions were tracked for 90 days after the discharge. To estimate an average
admission rate in a matched population, the average daily admission rate in the last quarter of the year was
calculated for a subset of PLF patients who had their operation in the first quarter of the year. Further, a
general baseline daily admission rate for any cause in patients age 45-64 was estimated from the 2013
National Health Interview Survey.

Results: Of 26,727 patients undergoing PLF, 1,580 patients (5.91% of the study population) were readmitted
within 30 days of discharge and 2,603 patients (9.74%) were readmitted within 90 days of discharge. Of
those readmitted within 90 days, 54.58% occurred in the first 30 days. However, if only counting
readmissions above the baseline admission rate of a matched population for the 4th quarter of the year
(0.08% of population/day), 94.61% occurred within the first 30 days.

Discussion/Conclusion: Although the number of readmissions after PLF almost doubled between 30 and 90
days, accounting for a baseline rate of readmissions for this population significantly affected the perceived
number readmitted due to the index operation. Determining baseline readmission rates will be an important
consideration if healthcare continues to move in the direction of bundled payments.

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Paper 13

90-day bundled payment for primary single level lumbar discectomy/decompression: what does
‘big data’ say?

Nikhil Jain, MD1, Sohrab Virk, MD2, Frank Phillips, MD3, Elizabeth Yu, MD1, Safdar Khan, MD2
1
Ohio State University, Columbus, Ohio, 2, Columbus, OH, 3, Chicago, IL

Background/Introduction: Episode based bundling is likely to soon become the major form of
reimbursement for many elective spine procedures. Assigning a uniform bundle amount will first
require extensive scrutinizing of existing reimbursement data to give an estimate of previous
payments and their distribution. This information is not known for a lumbar discectomy, which is
the most common elective spine procedure done in the outpatient setting. In this context, we
analyze the reimbursement data over the years from Commercial payers and Medicare for a
primary single level lumbar discectomy/decompression and simulate a 90-day payment bundle for
the same.

Materials/Methods: Administrative claims data was used to study reimbursements from
Commercial payers (2007–Q2 2015), Medicare Advantage (2007–Q2 2015), and Medicare (2005-
2012) for a primary single level lumbar discectomy/decompression. Distribution of payments
among various service providers was studied and a 90-day bundle was simulated. In addition to
descriptive analysis, variation between regions and payers was studied by a one way analysis of
variance (ANOVA) and post-hoc Tukey test, as appropriate.

Results: Average facility costs constituted 59.7 % to 73.6 % of total payments, followed by
surgeon’s fees which accounted for 13.7 to 18.5 %. Post-acute services made up 8.8 to 15.8 % of
the total reimbursement. The average 90-day bundle amount was estimated at $11,091, $6,571
and $6,239 for Commercial payers, Medicare Advantage and Medicare, respectively. Overall,
service providers in the Southern region were reimbursed the lowest from Commercial payers and
Medicare, compared to other regions. Surgeries performed in the inpatient setting were
significantly more expensive as compared to surgeries performed in the outpatient setting
(p<0.01).

Discussion/Conclusion: Facility costs constitute the maximum share and variation in
reimbursements. Surgery done as an inpatient is costlier than done in the outpatient setting.
Commercial payers reimburse almost double the amount of what Medicare does for a single-level
lumbar discectomy. There is regional variation in reimbursements for major clinical services,
however not uniform.

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Paper 14

National Trends for Spinal Deformity Surgery throughout the United States

Comron Saifi, MD1, Joseph Laratta, MD2, Jamal Shillingford, MD2, Joseph Lombardi, MD2, Nathan
Hardy, BS2, Andrew Pugely, MD2, Frank Phillips, MD3, Ronald Lehman, MD4, Howard An, MD5,
Lawrence Lenke, MD2
1
Midwest Orthopedics at Rush, Chicago, IL, 2, New York, NY, 3, Chicago, IL, 4, New York, NY, 5Rush
University Medical Center, Chicago, IL

Background/Introduction: Advancements in spinal instrumentation and imaging modalities have
given surgeons powerful new tools to achieve long construct fusions in spinal deformity surgery.
With increasing biomechanical knowledge of long constructs and a focus on health care utilization
and value-based care, it is essential to understand the demographic and economic data
surrounding fusions involving 9 or more levels in the United States.

Materials/Methods: The National Inpatient Sample (NIS) database was queried for patients who
underwent fusion or refusion of ≥ 9 vertebrae (ICD-9-CM 81.64) between 2004 and 2014 across 44
states. Demographic and economic data were obtained which included the annual number of
surgeries, age, sex, insurance type, location, and frequency of routine discharge. The NIS database
represents a 20% sample of discharges from U.S. hospitals, excluding rehabilitation and long-term
acute care hospitals, which is weighted to provide national estimates.

Results: In 2014, the estimated total number of fusions involving ≥ 9 vertebrae was 14,615 across
the United States. The number of fusions involving 9 or more levels has increased 141% from 6,072
in 2004. The mean cost associated with these procedures is $77,265 per case. The mean length of
stay (LOS) is 7.4 days in the adult population and 5.3 days in the pediatric population. Based on
payer, patients with private insurance comprised 44.1% of patients undergoing fusion of ≥ 9 levels
and Medicare comprised another 28.0% of patients.

Discussion/Conclusion: Throughout the United States, there was a progressive increase in the
number of long construct fusions involving ≥ 9 vertebrae. This trend is likely due to the improved
safety of the procedure and evolution of spinal instrumentation systems. Further cost analyses are
warranted to evaluate the overall societal impact of this increase in spinal deformity procedures.

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Paper 15

A Predictive Nomogram for Clinical Outcomes following Surgical Correction of Adult Spinal
Deformity

Akshay Sharma, BA1, Syed Mehdi, BS2, Sagar Vallabh, MS2, Emily Hu, BA2, Joseph Tanenbaum, BS2,
Michael Steinmetz, MD3, Edward Benzel, M.D.4, Thomas Mroz, M.D.4, Jason Savage, M.D.5
1
Case Western Reserve University, School of Medicine, Cleveland Heights, OH, 2Case Western
Reserve University School of Medicine, Cleveland, Ohio, 3Cleveland Clinic, Department of
Neurosurgery , Cleveland, OH, 4Cleveland Clinic Foundation, Neurological Institute, Cleveland,
OH, 5The Cleveland Clinic, Cleveland, Ohio

Background/Introduction: Re-alignment surgery for patients with adult spinal deformity has been
shown to improve quality of life outcome measures; however, large reconstructive surgery is
associated with significant morbidity. We sought to create a preoperative predictive nomogram to
determine which patients would benefit from surgery.

Materials/Methods: All patients aged 25-years-old with radiographic evidence of ASD and quality
of life data that underwent thoracolumbar fusion between 2008 and 2014 were retrospectively
identified. Demographic and clinical parameters were obtained. The EuroQol five dimensions
questionnaire (EQ-5D) was used to measure health-related quality of life (HRQoL) preoperatively
and at 12 months postoperative follow-up. A preoperative to postoperative decline of .04 or
greater was used to indicate the presence of clinically relevant decline in HRQoL.

Results: Our sample included data from 191 patients. 63% of patients experienced clinically
relevant postoperative decline in HRQoL. Seven variables were included in the final model:
preoperative EQ-5D score, sex, dyslipidemia, diagnosis (degenerative, idiopathic, or iatrogenic),
race, diabetes mellitus 2, and BMI. Female gender (OR 2.21, p = .036) and preoperative EQ-5D (OR
= 1.531, p < .0001) each were independently associated with the poorer postoperative outcome.

Discussion/Conclusion: Lower preoperative EQ-5D scores and female gender were associated with
a clinically significant decrease in postoperative EQ-5D scores, while race, diabetes mellitus type 2,
and BMI showed no significant association with post-operative quality of life outcomes. The
predictive nomogram that we developed using these data can improve preoperative risk counseling
and patient selection for deformity correction surgery.

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Paper 16

Frailty and Health Related Quality of Life Improvement Following Adult Spinal Deformity Surgery

Daniel Reid, MD, MPH1, Alan Daniels, MD2, Tamir Ailon, MD3, Justin Smith, MD4, Christopher
Shaffrey, MD5, Virginie Lafage, PhD6, Robert Hart, M.D.7, Emily Miller, MD8, Shay Bess, MD9,
Christopher Ames, MD10
1
Brown University/Rhode Island Hospital, Providence, Rhode Island, 2Department of
Orthopaedics, Division of Spine Surgery- Adult Spinal Deformity Service, Warren Alpert Medical
School of Brown University, Providence, Rhode Island, 3Vancouver Spine Surgery Institute,
Vancouver, BC, 4University of Virginia, Charlottesville, VA, 5University of Virginia Medical Center,
Charlottesville, VA, 6Hospital for Special Surgery, New York, NY, 7Oregon Health and Science
University, Portland, OR, 8The Johns Hopkins Hospital Departments of Orthopaedic Surgery and
Neurosurgery,, Baltimore, Maryland, 9, Denver, Colorado, 10University of California San Fransisco,
San Fransisco, CA

Background/Introduction: The Adult Spinal Deformity Frailty Index (ASD-FI) has been associated
with longer hospital stay and increased complications in patients undergoing surgery for adult
spinal deformity. The impact of frailty on postoperative changes in health-related quality of life
(HRQoL) is unknown. This study investigates the relationship between ASD-FI scores and HRQoL
scores measured at 2 years post-operatively.

Materials/Methods: This study was a retrospective review of a prospectively-collected multicenter
database. Patients who underwent ≥ 4 level instrumented fusion for ASD and had minimum 2-year
follow-up were stratified by ASD-FI score into the following categories: not frail 0-0.3 (NF); frail 0.3-
0.5 (F); and severely frail >0.5 (SF). We analyzed baseline demographic, HRQoL, and radiographic
parameters. The primary outcome measure was the proportion of patients who reached
substantial clinical benefit (SCB) in terms of Owestry Disability Index (ODI) score, SF-36 Physical
Component Score (PCS), and numeric back and leg pain scores in each frailty group. Secondary
outcomes included absolute values and 2-year post-operative changes in ODI, PCS, back and leg
pain.

Results: There were 332 patients who met inclusion criteria: 135 NF, 175 F, and 22 SF. F and SF
patients were significantly older, had more comorbidities, worse baseline HRQoL and pain scores,
and worse radiographic deformity (p<0.05). At 2-year follow-up, ODI, PCS, back pain, and leg pain
were all worse in F/SF than NF patients. More NF than F patients reached SCB for back pain (63.4%
vs. 57.5%, p=0.045). However, more F than NF reached SCB for ODI (43.7% vs. 29.3%; p=0.025), PCS
(56.9% vs. 51.2%; p=0.03), and leg pain (45.8% vs. 23.0%; p=0.03)

Discussion/Conclusion: Despite higher preoperative risk stratification scores, worse baseline
HRQoL scores, and greater complication rates, frail patients experienced greater improvement in
most HRQoL measures and overall greater likelihood of reaching substantial clinical benefit than
non-frail patients after undergoing surgery for adult spinal deformity.

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58
Paper 17

Outcomes of Open Staged Corrective Surgery in the Setting of Adult Spinal Deformity

Peter Passias, MD1, Gregory Poorman, BA2, Michael Gerling, MD1, Breton Line, BS3, Bassel Diebo, MD4,
Samantha Horn, BA1, Virginie Lafage, PhD5, Shay Bess, MD3, Thomas Errico, MD6, International Spine Study
Group (ISSG), -7
Hospital for Special Surgery, New York, NY1, New York, NY, 2, bronxville, ny, 3, Denver, Colorado, 4,
Brooklyn, NY, 5 Hospital for Special Surgery, New York, NY, 6, New York, New York, 7, Littleton, Colorado

Background/Introduction: Adult spinal deformity (ASD) represents a constellation of complex mal-
alignments affecting the spinal column. Corrective surgical procedures aimed at improving ASD can be
equally challenging, and commonly require multiple index procedures and potential revisions prior to
definitive management. There is a paucity of data comparing the outcomes of same-day (simultaneous) and
two-day (staged) procedures for long spinal-fusions for ASD. The purpose was to compare intra-operative,
peri-operative, and two-year outcomes of staged and simultaneous procedures correcting ASD.

Materials/Methods: Retrospective analysis of a prospective multicenter database. Inclusion criteria
included ASD patients ≥18yrs with 6-wk and 2 year follow-up. Propensity score matching identified similar
patients undergoing staged (STA) or simultaneous (SIM) long spine fusions based on Surgical Invasiveness,
Pelvic Tilt, and SVA. Complications, HRQLs (SRS22r, SF-36, ODI), and patient characteristics were compared
across and within treatment groups at follow-up with ANOVA and paired t-tests at 3 surgical stages: intra-
op, peri-op (6wk), and post-op (>6wk).

Results: 142 patients were included (71 STA, 71 SIM). Matching staged and simultaneous groups based on
degree of deformity and surgical invasiveness created two groups similar in overall correction of the surgery.
STA patients underwent more ALIF and LLIF interbody procedures while SIM patients had longer fusions.
Charlson Comorbidity Index and revision status were similar between groups (p>0.05). There were
significantly more complications causing reoperation in STA procedures (STA: 47% SIM: 8%, p=0.021). STA
had a greater number of peri-op complications requiring a return to the OR (STA: 9.9% SIM: 1.4% p=0.029).
There was no difference in intra-op complications, mortality, or peri-op infection or wound complications
(p>0.05). At 2 year follow-up, incidence of revision surgery was higher in STA (STA: 21.1% SIM: 8.5%,
p=0.033).

Discussion/Conclusion: Staged spinal fusions which add ALIFs and LLIFs to the procedure, compared to
similar-correction simultaneous procedures, result in similar intra-operative complication incidence, but
significantly higher rates of peri- and post-op complications leading to revision. Functional outcomes,
radiographic parameters, and mortality were similar. This will aid surgeons in their determination of optimal
treatment for such complex procedures.

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Paper 18

Visual Loss Following Spine Surgery: What Have We Seen Within the Scoliosis Research Society (SRS)
Morbidity and Mortality Database?

Jamal Shillingford, MD1, Joseph Laratta, MD1, Nana Sarpong, MD, MBA2, Ronald Lehman, MD3, Lawrence
Lenke, MD1, Charla Fischer, MD4
1
, New York, NY, 2Columbia College of Physician's and Surgeons, New York, NY, 3, New York, NY, 4Columbia
University Department of Orthopaedic Surgery, New York City, New York

Background/Introduction: The Scoliosis Research Society (SRS) compiles surgeon-reported complications
into a morbidity and mortality database, tracking particular postoperative complications including visual
loss, instrumentation failure, neurological deficits, infections, and death. Limited literature exists on
postoperative visual complications, a rare but devastating complication following spine surgery.

Materials/Methods: In this study, we utilized the SRS database to determine the patient profile,
perioperative risk factors, and prognosis for visual related complications in deformity patients undergoing
corrective spine surgery from 2009-2012.

Results: A total of 167,972 patients were identified with an overall visual acuity complication rate of 0.01%,
or 12.5 per 100,000 patients. The visual acuity complication rates for patients with scoliosis,
spondylolisthesis, and kyphosis were 0.01%, 0.01%, and 0.04% respectively. The 21 patients identified with
visual complications had a mean age of 34.8+-24.3years. Two patients (9.5%) had preoperative vision
changes, 2(9.5%) were diabetic, 2(9.5%) had vascular disease, 1(4.8%) had a history of thromboembolic
disease and 5(23.8%) had hypertension. Nineteen patients(90.5%) underwent a fusion procedure, 17(81%)
of which were posterior. Seventeen patients(81.0%) were positioned prone during surgery with an average
time in prone position of 264.2+-143.2minutes. Average intraoperative blood loss was 1409.6+-988.6mL’s.
The extent of visual loss was bilateral-partial in 4(19.0%), bilateral-total in 5(23.8%), unilateral-partial
8(38.1%), and unilateral-total in 3(14.3) patients. Four patients(19.0%) developed anterior ischemic optic
neuropathy(AION), 4(19%) posterior ischemic optic neuropathy(PION), 5(23.8%) central retinal artery
occlusion(CRAO), and 5(23.8%) cortical blindness(CB). Greater than 50% of the visual complications occurred
on or before the first postoperative day. Ten patients(47.6%) recovered complete vision and 4(19.0%)
experienced improvement. All patients with CB and 50% with PION experienced complete resolution. All
patients that had intraoperative head support with a commercial head-holder and 3 (75%) with tongs/halo
experienced complete resolution or improvement in vision. Trendelenburg and reverse Trendelenburg
positions were associated with complete resolution, while only 5(42%) patients positioned flat experienced
resolution.

Discussion/Conclusion: We conclude that visual complications occur in approximately 12.5 per 100,000
deformity patients, with a rate 4 times higher in patients with kyphosis. More than 50% of these
complications occur within 24 hours postoperatively. Nearly half of these complications resolve completely,
and another 20% improve postoperatively.

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61
Paper 19

Outcomes of Lumbopelvic Fixation for the Treatment of Adult Deformity with a Modified Iliac
Screw Starting Point

Ehsan Jazini, MD1, Kevin Khalsa, MD2, Tristan Weir, BS1, Kelley Banagan, MD1, Eugene Koh, MD,
PhD1, Steven Ludwig, MD1, Daniel Gelb, MD1, Luke Brown, MD1
1
, Baltimore, MD, 2University of Maryland, Baltimore, Baltimore, MD

Background/Introduction: Lumbopelvic fixation has been an important advancement in spine
surgery. However, Iliac screws are not without complications including infection, screw
prominence, and instrumentation failure(IF). Kasten et al. reviewed 78 patients treated with adult
deformity found a 11.5% infection rate. Literature review demonstrates pseudoarthrosis failure
rates between 5 and 15%. Our institution utilizes modified iliac screw starting points highlighted by
more medial starting points, placing iliac screw heads in line with S1 pedicle screws. We
hypothesize this technique is associated with decreased rates of elective screw removal secondary
to prominence, infection and IF.

Materials/Methods: Retrospective review between 2006-2015 of 57 patients undergoing
lumbopelvic fixation with a modified iliac screw starting site, for treatment of adult deformity
secondary to degenerative scoliosis, posttraumatic kyphoscoliosis, and flat back syndrome. Primary
outcome measure was rates of: 1) elective removal of Iliac screws, 2) infection , 3) IF (breakage of
rods/pelvic screws/pedicle screws), 4) revision surgery for Pseudoarthrosis/IF. Secondary outcome
measures: 1) EBL and 2) length of stay.

Results: Patient population consisted of 17.5% males and 82.5% females. The average age was 58.2
years old. Average follow-up was 22 months. Early infection rate (less than 1 month after primary
procedure requiring surgical intervention) was 3.5% and late infection rate (greather than 1 month)
was 12.2%. Overall infection rate was 15.7%. Elective removal of Iliac screws rate was 3.5 and IF via
radiographic review was 35%, but revision surgery rate for pseudoarthrosis/IF was 5.2%. Revision
surgery rate for proximal junctional failure/kyphosis was 3.5%. IF occurred below (N=15), above
(N=2), and both above and below (N=3) the L5 pedicle screw. Time of diagnosis of broken
instrumentation was 16 months. Average EBL was 1727cc, with length of stay 8.6 days.

Discussion/Conclusion: Our modified LPF technique demonstrated relatively low rates of elective
screw removal (3.5%), likely from decreased screw prominence. Infection rates were similar to
previously reported rates. The discrepancy between our relatively high rate of radiographic IF and
much lower revision surgery rate demonstrates the low clinical significance of radiographic findings
in isolation. The time to IF supports following patients with adult deformity reconstruction well
past the 1-year benchmark.

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63
Paper 20

Instrumentation Complication Rates Following Spine Surgery: A Report from the Scoliosis
Research Society (SRS) Morbidity and Mortality Database

Jamal Shillingford, MD1, Joseph Laratta, MD1, Nana Sarpong, MD, MBA2, Ronald Lehman, MD3,
Lawrence Lenke, MD1, Charla Fischer, MD4
1
, New York, NY, 2Columbia College of Physician's and Surgeons, New York, NY, 3, New York, NY,
4
Columbia University Department of Orthopaedic Surgery, New York City, New York

Background/Introduction: Surgical databases, like the Scoliosis Research Society (SRS) database,
have tremendous value in orthopaedic surgery. Beginning in 2004, the SRS has gathered surgeon-
reported complications, tracking particular postoperative complications including instrumentation
failure, blindness, new neurological deficits, infections, and death. To predict post-operative
morbidity and mortality in a set of deformity and degenerative spinal conditions, we utilized the
SRS database to assess demographic information and risk factors for instrumentation related
complications from 2009-2012.

Materials/Methods: The SRS Morbidity and Mortality database was queried for occurrences of
instrumentation complications in patients with a diagnosis of scoliosis, spondylolisthesis, and
kyphosis from 2009-2012. Variables assessed included preoperative comorbidities, intraoperative
and postoperative factors.

Results: A total of 167,972 patients were identified with an overall complication rate of 1.8% and
an instrumentation complication rate of 0.19%. There were a total of 96,636 patients with a
diagnosis of scoliosis, 54,901 with spondylolisthesis, and 16,435 with kyphosis and instrumentation
complication rates of 0.21%, 0.11%, and 0.27%, respectively. There were 311 patients (0.19%)
identified with instrumentation complications with a mean age of 38.5+-25.5 years.
Instrumentation complications occurred most commonly in scoliosis patients (66.2%), followed by
spondylolisthesis patients (18.6%) and kyphosis patients (14.5%). The most common comorbidities
included diabetes (10.7%), hypertension (23.5%), pulmonary disease (13.5%), smoking (8.7%) and
vascular disease (7.1%). Scoliosis curve magnitudes larger than 50 degrees represented 42.4% of
the cases that had an instrumentation complication. Fusion was performed in 86.2% and
osteotomies in 29.3% of these patients. Instrumentation related complications included implant
failure (23.3%), migration (28.3%), and malpositioned implants (48.6%). A new perioperative
neurologic deficit was noted in 146 patients (46.9%) with an instrumentation complication.

Discussion/Conclusion: Overall, the rate of instrumentation complications in deformity patients
was 0.19%, occurring more commonly in patients with a diagnosis of kyphosis with large curve
magnitudes. The potentially avoidable malpositioning of the spinal implants represents nearly 50%
of these complications. More attention to optimal intraoperative imaging or use of guidance,
navigation or robotic, may be of some utility in potentially decreasing these instrumentation
complications.
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65
Paper 21

Bone Morphogenetic Protein Use in Lumbar Spine Surgery in The United States: How Have We
Responded to The Warnings?

Javier Guzman, MD1, Robert Merrill, BS2, Jun Kim, MD1, Samuel Overley, MD 1, James Dowdell, MD1,
Sulaiman Somani, BS3, Andrew Hecht, MD1, Samuel Cho, MD4, Sheeraz Qureshi, MD, MBA 2
1
, New York, NY, 2Mount Sinai Medical Center, New York, NY, 3Icahn School of Medicine at Mount
Sinai, New York, New York, 4, NY, NY

Background/Introduction: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has
been widely adopted as a fusion adjunct in spine surgery since its approval in 2002. A number of
concerns regarding adverse effects of rhBMP-2 use led to an FDA advisory issued in 2008. A
separate warning about potential complications from rhBMP-2 was published by The Spine Journal
in 2011. The objective of this cross-sectional database study was to compare trends of rhBMP-2 use
in lumbar spine surgery after the FDA advisory in 2008 and The Spine Journal warning in 2011.

Materials/Methods: We conducted a retrospective cross-sectional study using the Nationwide
Inpatient Sample (NIS) from 2002-2013. Using international classification of disease, ninth revision
(ICD-9-CM) procedure codes, we identified lumbosacral spinal fusion procedures and identified the
proportion that used rhBMP-2. The percentage of cases utilizing rhBMP-2 was plotted across time.
A linear regression was fit to the data from quarter 3 of 2008 (FDA advisory) through quarter 1 of
2011, and a separate regression was fit to the data from quarter 2 of 2011 (Spine J warning)
onwards. The slopes of these lines were statistically compared to determine differences in trends.

Results: A total of 2,185,114 lumbosacral spinal fusion were performed between 2002 and 2013.
We observed a greater rate of decreased rhBMP-2 use after The Spine Journal warning (-1.13%
cases/quarter) compared to the FDA advisory (-0.14% cases/quarter) for all lumbosacral fusions
(p=0.0008)(fig. 1). Anterior lumbosacral procedures continued to increase rate of rhBMP-2 use
after the FDA advisory (0.19% cases/quarter), but decreased rate of rhBMP-2 use after The Spine
Journal article (-1.39% cases/quarter)(p=<0.0001). Similarly, posterior procedures had an increased
rate of rhBMP-2 use of 0.42% cases/quarter after the FDA advisory, and a decline in rate of rhBMP-
2 use of -1.10% cases/quarter after The Spine Journal article (p=<0.0001).

Discussion/Conclusion: Our results suggest that warnings sanctioned through the spine literature
may have a greater influence on practice of the spine surgery community as compared to
advisories issued by the FDA. The spine literature may be a valuable tool to establish
comprehensive guidelines regarding safe and effective use of rhBMP-2.

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Paper 22

National Trends in the Utilization of Intraoperative Neuromonitoring throughout the United
States

Joseph Laratta, MD1, Nathan Hardy, BS1, Jamal Shillingford, MD1; Joseph Lombardi, MD1, Comron
Saifi, MD2, Andrew Pugely, MD1, Howard An, MD3, Frank Phillips, MD4, Ronald Lehman, MD5,
Lawrence Lenke, MD1
1
, New York, NY, 2Midwest Orthopedics at Rush, Chicago, IL, 3Rush University Medical Center,
Chicago, IL, 4, Chicago, IL, 5, New York, NY

Background/Introduction: Intraoperative electrophysiological neuromonitoring is technique aimed
at reducing neurologic morbidity during operative manipulations of the spinal column. The
multimodal neuromonitoring technique has evolved over the past decade and may alert the
surgeon to changes in the central nervous system prior to irreversible injury. Our group
hypothesized that the use of intraoperative neuromonitoring during spine surgery has increased
over the study period.

Materials/Methods: The National Inpatient Sample (NIS) database queried for the intraoperative
monitoring of central nervous electrical activity (ICD-9-CM 00.94) between 2007 and 2014 across
44 states. Demographic and economic data were obtained which included the annual number of
surgeries, age, sex, insurance type, location, and frequency of routine discharge. The NIS database
represents a 20% sample of discharges from U.S. hospitals, weighted to provide national estimates.

Results: The estimated use of intraoperative neuromonitoring of central nervous electrical activity
increased 3050% from 3,995 cases in 2007 to 125,835 cases in 2014. The greatest use of
intraoperative neuromonitoring occurred in patients between the ages of 45 and 64 (44.5%). Based
on payer, privately insured patients, rather than Medicare or Medicaid patients, were more likely
to undergo intraoperative monitoring during spinal procedures (45.0% versus 36.8% versus 9.2%,
respectively). When stratifying by median income for patient zip code, there was a substantial
difference in the rate of monitoring for central nervous electrical activity between low and higher
income groups (19.9% versus 78.1%, respectively). Moreover, monitoring of central nervous
electrical activity was significantly more likely to be utilized at urban teaching hospitals rather than
nonteaching hospitals or rural centers (72.9% versus 25.0% versus 2.2%, respectively).

Discussion/Conclusion: Over the past decade, there has been a shift in the practice of utilizing
intraoperative monitoring of central nervous electrical activity. This is likely due to its proven
benefit in reducing neurologic morbidity, without introducing additional risk. While
neuromonitoring may improve patient care, it is still rather isolated to teaching hospitals and
patients from higher income zip codes.

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Paper 23

Circumferential Fusion: A Comparative Analysis Between ALIF and TLIF for the Indication of L5-S1
Isthmic Spondylolisthesis

Erik Tye, B.A.1, Andrea Alonso, B.S.2, Joseph Tanenbaum, BS3, Roy Xiao, B.A.1, Thomas Mroz, M.D.4,
Michael Steinmetz, MD5, Jason Savage, M.D.6
1
, Cleveland, OH, 2Case Western Reserve University School of Medicine, Cleveland Heights, Ohio,
3
Case Western Reserve University School of Medicine, Cleveland, Ohio, 4Cleveland Clinic
Foundation, Neurological Institute, Cleveland, OH, 5Cleveland Clinic, Department of Neurosurgery
, Cleveland, OH, 6The Cleveland Clinic, Cleveland, Ohio

Background/Introduction: Circumferential fusions with either transforaminal lumbar interbody
fusion (TLIF) with posterolateral fusion (PLF) or anterior lumbar interbody fusion (ALIF) with PLF
offer significantly higher radiographic fusion rates than other fusion techniques for L5-S1 isthmic
spondylolisthesis (IS). It is unclear which of the two procedures is optimal in the management of
adult IS. No study to date has compared these techniques for treatment of L5-S1 IS. This study aims
to provide evidence to guide spine surgeons towards the preferred surgical approach.

Materials/Methods: A retrospective review was performed of patients who underwent TLIF and
PLF or ALIF and PLF for L5-S1 IS. Patient demographic data including age, gender, race, body mass
index (BMI), medications, and smoking status/history were collected. Operative information
including procedure time, blood loss and perioperative complications were also collected. Quality
of life outcome scores, radiographic data, and financial data were collected with a minimum of 1-
year follow up.

Results: A total of 66 patients met inclusion criteria. In the ALIF cohort, PDQ scores improved from
66.2±28.2 to 46.1±28.9 (p=0.01). In the TLIF cohort, PDQ scores improved from 66.3±26.6 to
44.2±38.9 (p<0.01). However, the ALIF group showed a significantly greater improvement in EQ5D
scores at 1 year (0.2±0.2 vs. 0.1±0.2, p=0.03). Of note, neither group met the minimally clinical
important difference (MCID) for PDQ or EQ5D scores. Furthermore, segmental lordosis was only
significantly increased in the ALIF cohort (20.5±5 to 25.9±6.5, p=0.002). The ALIF cohort showed a
significantly greater improvement in disc height restoration compared to TLIF (4.0±2.4 vs. 6.9±3.3,
p<0.01). No significant differences were found with regards to costs for both procedures.

Discussion/Conclusion: Our findings are in support of the ALIF technique as being the most reliable
fusion procedure for the treatment of IS. We believe the superior radiographic outcomes achieved
through ALIF, namely a greater restoration of segmental lordosis and disc height may have
contributed to the greater clinical outcomes presented in the current study. These promising
results can perhaps help clarify the contentious debate among the surgical community with regards
to which surgical technique is most appropriate in the treatment of isthmic spondylolisthesis.

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71
Paper 24

Treatment of Chronic Low Back Pain via Ablation of the Basivertebral Nerve: Results of the
SMART Trial

Alfred Rhyne, MD1, Jeffrey Fischgrund, MD2, Rick Sasso, MD3, Hyun Bae, MD4, Eeric Truumees, MD5,
Philip Yuan, MD6, Michael DePalma, MD7, Bernhard Meyer, MD8, Jorg Franke, Dr.9
1
OrthoCarolina, Charlotte, North Carolina, 2, Royal Oak, Michigan, 3, Carmel, IN, 4Cedars-Sinai
Spine Center, Los Angeles, CA, 5Seton Spine and Scoliosis Center, Austin, TX, 6Memorial
Orthopedic Surgical Group, Long Beach, California, 7Virginia iSpine , Richmond, Virginia, 8Depart
of Neurosurgery Technical Univ. of Munich, Munich, Klinikum rechts der Isar, 9Klinik fur
Orthopaedie C. Wirbelsaulen-und Kinderorthopadie, Magdeburg, gemeinnutzige GmBH

Background/Introduction: The basivertebral nerve (BVN) is a sensory nerve within the vertebral
body, whose role in pain transmission is thought to be a source of chronic low back pain associated
with degenerative changes. The use of a radiofrequency system (INTRACEPT TM System) for
ablation of the BVN was tested in this trial.

Materials/Methods: 225 patients with chronic low back pain, 6 months of conservative care and no
neurogenic leg pain were enrolled at 18 sites in the United States and Germany in this prospective,
double blinded, randomized, sham controlled trial (147 active vs 78 sham arm). MRI had to
demonstrate Type 1 or 2 Modic changes at <3 contiguous vertebral bodies. Follow-up was at 2 and
6 weeks, 3, 6 and 12 months. Patients and physicians providing postoperative care were blinded to
allocation until the conclusion of the one year follow-up. For sham patients, there was an optional
crossover after all 12-month evaluations.

Results: Targeting success (assessed by postop MRI) was achieved in 96.4% of the treated and
evaluated vertebral bodies. Primary end point analysis in the per protocol population at 3 months
showed that the ODI improvement in the active arm was superior to the sham arm (p=0.019) mean
improvement was 20.5 points. This result was sustained through two years of follow-up. An
analysis of ODI responder rates found that 75.6% of the RF ablation treated patients demonstrated
a greater than 10-point clinically meaningful improvement in their low back pain and associated
disability at 3 months. There were no adverse device effects and no device related serious adverse
events. The rates of neurological events reported were low and comparable between treatment
arms.

Discussion/Conclusion: BVN ablation with the INTRACEPTTM System proved to be safe and
effective for the treatment of chronic low back pain in this patient population based on the primary
end point results showing a significantly greater improvement in ODI for the arm.

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Paper 25

Trend of Spine Surgeries In the Outpatient Hospital Setting vs. Ambulatory Surgical Center

Olumuyiwa Idowu, BA1, Haroutioun Boyajian, MD2, Edwin Ramos, MD2, Lewis Shi, MD2, Michael
Lee, M.D.3
1
, Chicago, Illinois, 2, Chicago, IL, 3University of Chicago Medical Center, Chicago, IL

Background/Introduction: Recent studies have assessed the safety, satisfactory clinical outcomes,
and increasing utilization of lumbar spinal surgeries performed in the outpatient setting. No studies
have delineated between true ambulatory settings and outpatient hospitals when assessing the
rates of these procedures. The aim of this study was to examine how often spine surgery is being
performed in an outpatient hospital setting vs. a more “true” ambulatory setting, specifically
ambulatory surgery centers (ASCs) where admission and discharge are required on the same
calendar day.

Materials/Methods: A retrospective review of the Truven Health Marketscan® Research Databases
was conducted for patients undergoing lumbar spine operations between 2003 and 2014. The
frequency of each CPT code was identified per year, and then categorized into each of “inpatient
hospital”, “outpatient hospital”, or “ASC” in states that clearly define ASCs as facilities where
patients are discharged on the same calendar day of the operation, and do not stay overnight.

Results: The percentage posterior lumbar fusion 1st level performed as an inpatient procedure
decreased from 98.9% in 2003 to 93.2% in 2014, while during the same time period, its percentage
as an outpatient hospital and ASC procedure increased from 0.9% to 4.9%, and from 0.2% to 2%,
respectively. The changes in trends for lumbar decompression laminotomy 1st level were more
dramatic with the percentage performed as an inpatient procedure decreasing from 80.6% in 2003
to 20.9% in 2014, while during the same time period, its percentage as an outpatient hospital and
ASC procedure increasing dramatically from 18.7% to 68.5%, and from 0.7% to 10.6%, respectively.

Discussion/Conclusion: “True” ambulatory surgeries are not increasing at the same rate as
outpatient procedures with 23 hour observation capacity, and although prior studies have
demonstrated the safety of outpatient spine surgery, this data suggests that most surgeons feel
that this safety may not be comparable to that of other outpatient procedures.

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Paper 26

Body Mass Index is Not Associated with Inpatient Pain Scores or Postoperative Narcotic
Consumption following a Minimally Invasive Transforaminal Lumbar Interbody Fusion

Ankur Narain, BA1, Fady Hijji, BS1, Dustin Massel, BS2, Benjamin Mayo, BA2, Daniel Bohl, MD, MPH3,
Krishna Kudaravalli, BS1, Kelly Yom, BA1, Kern Singh, MD2
1
, Chicago, IL, 2Rush University Medical Center, Chicago, IL, 3Rush University Medical Center, New
Haven, CT

Background/Introduction: Current literature reports successful outcomes following minimally
invasive transforaminal lumbar interbody fusion (MIS TLIF); however, inpatient pain scores across
body mass index (BMI) category have not been previously reported. The purpose of this study is to
examine patient-reported inpatient pain scores in the immediate postoperative period by BMI
category following MIS TLIF.

Materials/Methods: A prospectively maintained surgical database of patients who underwent a
primary, one-level MIS TLIF for degenerative spinal pathology between 2010-2015 was reviewed.
Patients were stratified according to BMI: normal weight (<25 kg/m2), overweight (25-29 kg/m2),
obese I (30-34 kg/m2), or obese II-III (≥35 kg/m2). The effect of BMI on surgical outcomes, narcotic
consumption, and inpatient pain scores was analyzed using Poisson regression with robust error
variance or linear regression adjusted for patient demographics and preoperative characteristics.

Results: A total of 305 patients were included in the analysis, of which 56 (18.4%) were normal
weight, 110 (36.1%) were overweight, 68 (22.3%) were obese I, and 71 (23.3%) were obese II-III.
Normal weight and obese II-III patients had lower percentage of smokers (Normal: 8.9%;
Overweight: 17.3%; Obese I: 27.9%; Obese II-III: 12.7%; p=0.026), while a greater BMI was
associated with having an increased comorbidity burden (Normal: 1.9; Overweight: 2.6; Obese I:
2.5; Obese II-III: 3.2; p=0.015), increasing mean operative time (Normal: 113.2; Overweight: 116.3;
Obese I: 119.4; Obese II-III: 136.7 minutes; p=0.005), and a trend towards increasing hourly
inpatient VAS pain scores on POD 0 (Normal: 5.1; Overweight: 5.3; Obese I: 5.6; Obese II-III: 5.6;
p=0.322), POD 1 (Normal: 4.5; Overweight: 4.9; Obese I: 4.9; Obese II-III: 5.3; p=0.194), and POD 2
(Normal: 4.6; Overweight: 4.7; Obese I: 5.0; Obese II-III: 5.4; p=0.053) as well as OME consumption
(Normal: 2.6; Overweight: 2.6; Obese I: 2.7; Obese II-III: 3.1; p=0.066) on POD 2, although this result
was not statistically significant.

Discussion/Conclusion: The results of this study suggest patients with a greater BMI do not report
increased pain or require increased narcotic consumption in the immediate postoperative period
despite prolonged operative times. As such, the postoperative analgesia protocol should not differ
across BMI stratifications.

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Paper 27

An Analysis of Robotic Assisted Pedicle Screw Placement

Joseph Lombardi, MD1, Joseph Laratta, MD1, Jamal Shillingford, MD1, Mark Weidenbaum, MD2,
Ronald Lehman, MD3, Charla Fischer, MD4
1
, New York, NY, 2Columbia University Medical Center, New York, NY, 3, New York, NY, 4Columbia
University Department of Orthopaedic Surgery, New York City, New York

Background/Introduction: The use of robotic assistance for the placement of pedicle screws
continues to gain in popularity. Its proposed advantages are especially marked in instances of
advanced scoliotic deformity or complex revision surgery. This study aims to evaluate the early
experience at a single institution with the use of robotically assisted pedicle screw placement.

Materials/Methods: A retrospective review was performed on all patients who underwent spine
surgery with use of a robotic assisted pedicle screw placement system. All surgeries were
performed by three fellowship trained spine surgeons at a single institution from the time period of
January 1st, 2016 to July 1st, 2016. Three independent researchers documented data from the
operative reports, imaging modalities and technical notes of each surgeon. Screws were classified
as A) successfully placed by robot, B) breech or malposition of screw placed by robot, or C) robot
placement aborted in favor of manual instrumentation. Other data points recorded included
percutaneous versus open screw placement, number of surgical levels instrumented as well as
rates of screw complications which occurred during each attending’s first ten cases versus all
subsequent cases.

Results: Robotic assisted pedicle instrumentation was successfully utilized in 54 of 63 patients
(85.7%) who met inclusion criteria. Of all patient’s enrolled, 412 of an attempted 456 pedicle
screws were successfully instrumented (90%). Thirty-eight screws were unable to be placed due to
loss of registration (8.3%). Six screws were deemed to be placed in malposition based on
intraoperative xray and/or CT scan and required removal and re-instrumentation (1.3%). Forty-two
of the forty-four screws (95%) that were unable to be placed by the robot were in the open surgery
group (p=0.05). There was no difference detected in unsuccessful screw placement during each
operators’ first ten cases versus subsequent cases. There was a statistically significant difference in
screw malpositioning/registration errors occurring in spinal surgery greater than 3 levels. (p=0.04).

Discussion/Conclusion: Use of robotic assisted pedicle screw placement is a safe an effective
means of instrumenting the spine when registration is achieved. Open surgery and cases greater
than 3 levels typically involve more complex anatomy, which likely accounts for higher rates of
registration failure.

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Paper 28

Postoperative Outcomes Following Primary Minimally Invasive Transforaminal Lumbar Interbody
Fusion with Unilateral or Bilateral Interbody Cages

Ankur Narain, BA1, Fady Hijji, BS1, Krishna Kudaravalli, BS1, Kelly Yom, BA1, Kern Singh, MD2
1
, Chicago, IL, 2Rush University Medical Center, Chicago, IL

Background/Introduction: Controversy exists regarding the utilization of unilateral versus bilateral
interbody cages in minimally invasive transforaminal lumbar interbody fusion procedures (MIS
TLIF). Few studies have analyzed postoperative patient reported outcomes (PROs) as they relate to
the use of unilateral versus bilateral cages. In this context, the purpose of this study is to determine
differences in improvements in Oswestry Disability Index (ODI), Short Form-12 Physical Composite
Summary (SF-12 PCS), and back and leg pain in patients undergoing MIS TLIF with unilateral versus
bilateral interbody cages.

Materials/Methods: A prospectively maintained surgical database of patients who underwent a
one-level, primary MIS TLIF for degenerative pathology with either unilateral or bilateral interbody
cages between 2010-2016 was reviewed. Patients were excluded if there was incomplete
preoperative PRO data. Improvements in PRO scores between instrumentation cohorts were
compared using linear (continuous) or Poisson regression with robust error variance (categorical)
adjusted for patient demographics, procedural characteristics, and preoperative PRO score.

Results: After exclusion of those with incomplete preoperative PRO data, 64 patients were included
in this analysis. Of these, 44 (68.75%) underwent primary MIS TLIF with unilateral cages and 20
(31.25%) underwent MIS TLIF with bilateral cages. The unilateral cage cohort was older (53.02 vs
46.59 years, p=0.031), had a greater comorbidity burden (1.86 vs 1.00, p=0.031), and was more
likely to have a preoperative diagnosis of degenerative spondylolisthesis (43.19% vs. 15.00%,
p=0.007). The bilateral cage cohort exhibited a trend towards being more likely to have a
preoperative diagnosis of isthmic spondylolisthesis (65.00% vs. 31.82%, p=0.077). There were no
differences in operative time, estimated blood loss, or length of stay between cohorts (p>0.05 for
each). Additionally, there were no significant differences in improvement in ODI, SF-12 PCS, VAS
Back, or VAS Leg scores at 6-week, 12-week, and 6-month postoperative follow-up (p>0.05 for
each).

Discussion/Conclusion: The results of this study suggest that patients undergoing MIS TLIF with
bilateral cage instrumentation have increased disease severity. Despite this discrepancy in
diagnosis, both cohorts experience similar improvements in PROs at all postoperative time points.
Thus, practitioners and patients should expect similar improvements in disability and pain
irrespective of necessity for bilateral cage instrumentation.

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Paper 29

Lateral lumbar interbody fusion approach and relationship of the ureter: Anatomical study with
application to minimizing complications

Doniel Drazin, MD, MA1, Vlad Voin, NA2, Filipe Sanders, NA2, Marios Loukas, MD, PhD2, Rod
Oskouian, MD3, R. Tubbs, PhD4
1
Swedish Neuroscience Institute, Seattle, WASHINGTON, 2, Seattle, WASHINGTON, 3, Seattle, WA,
4
Seattle Science Foundation, Seattle, Washington

Background/Introduction: Complications from lateral lumbar interbody fusion procedures range
from neurological deficits to damage to organs and blood vessels. Although apparently uncommon,
damage to the ureter has been reported. To better understand the anatomical relationship of the
ureter to this surgical approach, the present anatomical study was performed.

Materials/Methods: Eight adult cadavers (16 sides) were placed in the full lateral position. Next, an
incision was made between the iliac crest and 12th rib. The retroperitoneal space was entered
without disturbing the position of the kidney or ureter. The position of the ureter in relationship to
the lumbar vertebrae was documented. Next, the distal ureter was cannulated with a metal wire,
which was passed up to the kidney. Fluoroscopy was then obtained to note the position of the
ureter in regard to the bony anatomy in this region.

Results: The ureter was easily identified on all sides and there were no signs or medical
documentation of prior abdominal surgery or evidence of congenital malformations involving the
kidney or ureters. From the direct lateral position and on all sides, the ureter was found to lie
below the plane of the lumbar vertebral bodies and more so proximally. With the descent of the
ureter, especially at L4 and L5, the ureter gradually moved to a more anterior position, i.e. closer to
the anterior aspect of the vertebral body. On all sides, the ureter, from a lateral perspective,
crossed the posterior third of the upper lumbar vertebrae, approached the middle third at L3, and
reached the anterior third at L4/L5 before descending into the pelvis.

Discussion/Conclusion: Due to the proximity of the ureter to the lumbar vertebral bodies, it is
imperative to verify that this structure is not in the surgical trajectory during lateral lumbar
interbody fusion procedures, in order to avoid ureter damage.

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Paper 30

Pain-Related Functional Changes in a Rodent Model of Intervertebral Disc Degeneration

Elizabeth Leimer, BS1, Matthew Gayoso, n/a1, Liufang Jing, MS2, Adam Elkhayat, BS1, Lori Setton,
Ph.D.2, Munish Gupta, MD1
1
, St Louis, MO, 2Washington University in St. Louis, St. Louis, MO

Background/Introduction: Surgical puncture of the lumbar intervertebral disc (IVD) in animal
models induces structural damage and leads to IVD degeneration over time. Prior rodent IVD
degeneration models have involved injury to multiple IVDs, which confounds the mechanism of
pain generation. This study identifies a behavioral and pain-related sensitivity phenotype after
puncture of one lumbar IVD.

Materials/Methods: Baseline functional assessments including static weight-bearing, gait analysis,
site-specific algesia, and open field testing were done for Sprague-Dawley rats (n=36, 18 weeks old)
the day before lumbar IVD puncture surgery (LDP). The L5-L6 IVD of the LDP group (n=14) was
exposed and punctured with a 27 gauge needle. The sham group (n=14) had L5-L6 IVD visualization
only and naïve animals (n=8) had no surgery. Animals repeated functional assessments on weeks 1,
4, 6, 8, 12, 16, 18, and 20 weeks post-surgery.

Results: Acute changes in the gait parameters of hind limb stride length, hind limb duty factor,
stance-to-swing ratio, and stance width were observed in the LDP and sham groups following
surgery; all of these gait changes resolved by post-operative week 6. In measures of static weight-
bearing, acute changes in left hind limb weight-bearing of the LDP group similarly resolved by post-
operative week 4. Animals in the LDP group presented with increased hind limb stride length at
post-operative week 18 (p<0.001), and with decreased left hind limb weight-bearing (p<0.05) as
shown in Figure 1.

Discussion/Conclusion: Our data indicate that rats do not fully recover from the soft tissue trauma
and acute pain induced by LDP surgery until 4-6 weeks post-surgery. Gait and weight-bearing
changes observed at post-operative week 18 may be more consistent with the presentation of a
“chronic” degenerative disc disease. This timeline of acute injury and healing followed by a
sustained pain-free period and subsequent development of sensitivity and gait changes suggests
that this model of IVD degeneration may have some relevance to the clinical development of
discogenic pain in humans.

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Paper 31

Comparison of the Efficacy of Adipose-Derived and Bone Marrow-Derived Stem Cells in a Rat
Model of Spinal Fusion

Christina Holmes, PhD1, Wataru Ishida, MD2, Benjamin Elder, MD, PhD2, John Locke, _3, Timothy
Witham, MD1
1
Johns Hopkins University School of Medicine, Baltimore, MD, 2Johns Hopkins University School of
Medicine, BALTIMORE, Maryland, 3, BALTIMORE, Maryland

Background/Introduction: Bone marrow-derived stem cells (BMSCs) have been widely used in
spinal fusion studies, however, adipose-derived stem cells (ADSCs) offer a number of key
advantages, including larger available tissue volume, higher stem cell concentrations and reduced
donor site morbidity. In this study we compare the efficacy of ADSCs and BMSCs in achieving
successful spinal fusion when combined with a clinical-grade bone graft substitute in a rat model.

Materials/Methods: ADSCs were isolated from the inguinal fat pads, while BMSCs were isolated
from the long bones of syngeneic female 6-8 week old Lewis rats and cultured in vitro until passage
2 for subsequent transplantation. The frequency of colony forming unit fibroblast (CFU-F) colonies
for both ADSCs and BMSCs was assessed in vitro. Posterolateral spinal fusion surgery at L4-5 was
performed on 36 female Lewis rats (6-10 wk old) divided into 3 experimental groups: [1] Vitoss
(Stryker) bone graft substitute only (n=12); [2] Vitoss + 2.5 x 10^6 ADSCs/side (n=12); and [3] Vitoss
+ 2.5 x 10^6 BMSCs/side (n=12). Fusion was assessed 8 weeks post-surgery via micro-computed
tomography (MicroCT) analysis and manual palpation. Manual palpation scoring was conducted by
blinded researchers as follows: 0 = non-fused; 1 = partial fusion, some motion across operative
joint; 2 = fused, no motion across the operated joint.

Results: MicroCT imaging analyses indicated that the average fusion volume in the ADSC group was
significantly higher than in the BMSC and VO groups (44.3 mm^3 vs. 27.6 and 30.0 mm^3,
respectively, p < 0.01). Similarly, average manual palpation score was the highest in the ADSC group
compared with the BMSC and VO groups (1.5 versus 0.7 versus 0.8p = 0.03). As in previous studies,
ADSCs exhibited a faster proliferative rate and a higher CFU-F frequency than BMSCs in vitro.

Discussion/Conclusion: When combined with a clinical grade bone graft substitute in a rat model,
ADSCs yielded increased fusion mass volume and rates of fusion than bone marrow-derived stem
cells. Ongoing studies will explore whether freshly isolated ADSCs will yield similar results.

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Paper 32

Intrawound Tobramycin Powder Eradicates Surgical Wound Contamination: An in Vivo Rabbit
Study

Joseph Laratta, MD1, Jamal Shillingford, MD1, Nathan Hardy, BS1, Joseph Lombardi, MD1, Comron
Saifi, MD2, Alexander Romanov, DVM1, Charla Fischer, MD3, Ronald Lehman, MD4, Lawrence Lenke,
MD1, K Riew, MD1
1
, New York, NY, 2Midwest Orthopedics at Rush, Chicago, IL, 3Columbia University Department of
Orthopaedic Surgery, New York City, New York, 4, New York, NY

Background/Introduction: Implant-associated surgical site infections (SSI) remain a dreaded
complication of spinal surgery. Currently, over 30% of all spine SSIs are secondary to gram-negative
bacteria. The purpose of the present study was to assess the efficacy of intrawound tobramycin
powder in terms of eradicating a known bacterial contamination in an Escherichia coli infected
rabbit spinal implantation model.

Materials/Methods: Twenty New Zealand White female rabbits underwent simulated partial
laminectomies and implantation of a 10mm titanium wire at L5-L6. All surgical sites were
inoculated with 100uL of tobramycin-sensitive E. coli (EC ATCC 25922, 1 x 10^8 colony-forming
units [CFU]/mL). Prior to closure, tobramycin powder (160mg) was placed into the wound of ten
rabbits. The rabbits were sacrificed on postoperative day four. Tissue and wire samples were
explanted for bacteriologic analysis. A Fisher exact test was used to assess differences in categorical
variables and an independent samples t test was used to assess mean group differences.

Results: The experimental and control rabbits were similar in weight (mean [and standard
deviation], 3.22 ± 0.12 kg and 3.22 ± 0.14 kg, respectively, p = 1.0), sex distribution and duration of
surgery (13.1 ± 2.4 min and 11.6 ± 2.1 min, p = 0.39). Bacterial cultures of the tissue samples were
negative for all ten tobramycin-treated rabbits and positive for all ten control rabbits (p < 0.0001).
Bacterial growth occurred in thirty-nine of forty samples from control rabbits, but zero of the forty
samples from the tobramycin group (p < 0.0001). Blood culture samples from all rabbits were
negative. No rabbit had evidence of sepsis or tobramycin toxicity.

Discussion/Conclusion: In a rabbit spine-infection model, intrawound tobramycin eliminated E. coli
surgical site contamination. All rabbits that did not receive intrawound tobramycin had persistent
E. coli contamination.

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Paper 33

Topical Intraoperative Antibiotic Administration and Fusion: A Comparison of Vancomycin and
Tobramycin in a Rat Model.

Wataru Ishida, MD1; Christina Holmes, PhD2, Benjamin Elder, MD, PhD1, John Locke, _3, Timothy
Witham, MD2
1
Johns Hopkins University School of Medicine, BALTIMORE, Maryland, 2Johns Hopkins University
School of Medicine, Baltimore, MD, 3, BALTIMORE, Maryland

Background/Introduction: Local intraoperative administration of antibiotics in spinal fusion
procedures has become an increasingly common prophylactic measure in an attempt to reduce
rates of post-surgical infection. The localized intraoperative use of vancomycin powder remains
controversial in spinal fusion, although some clinical studies have suggested that it is safe and may
reduce rates of infection (Khan et al, 2014, J Neurosurg Spine 21:974–983; Bakhsheshian et al,
2015, World Neurosurg, 83(5):816-823). We thus aim to examine the effects of local intraoperative
delivery of vancomycin powder and tobramycin powder, an antibiotic commonly used in
orthopaedic bone grafting surgeries, in a rat spinal fusion model.

Materials/Methods: Bilateral posterolateral intertransverse process lumbar spinal fusion surgery
was performed at L4-L5 using syngeneic iliac crest allograft mixed with Vitoss (Stryker) bone graft
substitute and varying concentrations of antibiotics. Sixty female Lewis rats (6-8 week old) were
divided into five experimental groups: [G1] low concentration (14.3 mg/kg) vancomycin (n=12);
[G2] high concentration (71.5 mg/kg) vancomycin (n=12); [G3] low concentration (28.6 mg/kg)
tobramycin (n=12); [G4] high concentration (143 mg/kg) tobramycin; and, [G5] controls with no
antibiotics (n=12). Eight weeks post-surgery fusion was evaluated via microCT analysis (CT scoring
per side: 2 = robust fusion; 1 = some narrowing of fusion mass; and, 0 = discontinuity of fusion
mass; total score = average of sum of both sides), manual palpation and histology.

Results: Preliminary microCT data indicated that the high-dose vancomycin group [G2] exhibited a
significantly lower fusion score and fusion mass volume than controls (fusion scores: [G1]1.8,
[G2]1.2, [G3] 1.6, [G4] 3.0, and [G5] 2.3, respectively, p=0.045; fusion volumes: [1]20.7, [2]15.5,
[3]22.9, [4]34.9, and [5]31.5 mm^3, respectively, p=0.002). Manual palpation and histological
analysis are currently being performed.

Discussion/Conclusion: Preliminary data suggest that the intraoperative local application of
vancomycin at supraphysiological doses may have detrimental effects on spinal fusion rates, thus
suggesting that caution may be required when considering the amount of intraoperative
vancomycin powder to employ in certain fusion patients.

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Paper 34

The Effectiveness of Personalized Electronic Patient Engagement Messaging Following Lumbar
Spinal Fusion: A Pilot Study

Louis Jenis, MD1, Tricia Gordon, NP2, Thomas Cha, MD, MBA3, Joseph Schwab, MD, MS3
1
Massachusetts General Hospital, Boston, MA, 2, Boston, MA , 3MGH, Boston, MA

Background/Introduction: While much focus has been placed on preoperative patient optimization
less attention has been given to immediate postoperative period and identifying potential means of
motivating patients and directing behaviors. The field of population health management has
attempted to understand the health of the individual patient and proactively utilize and connect
the patient to optimal medical resources. Patients are routinely segmented by age, demographics
and insurance however this provides detail on “what the patient is doing” and not “why the patient
is behaving in a certain manner”. Previous research has identified 5 healthcare related patient
psychographic segments each unique in its own motivations and communication preferences, i.e.
voice mail, text messaging,etc.. The goal of this study was to apply psychographic segmentation to
patients undergoing lumbar spine surgery and utilize a series of electronic, customized, automated
messages designed to better prepare patients preoperatively and postoperatively and to monitor
progress, proactively detect any recovery issues, and limit 30-day readmission while enhancing
patient satisfaction.

Materials/Methods: We enrolled 69 consecutive patients undergoing posterior instrumented
lumbar fusion surgery (60.48years - 32-84). Patients received automated communication 5 and 2
days prior to surgery with prep videos and education. Each patient was also communicated with
postoperatively on day 2, 4, 6, 10, 14 and 21.

Results: Each psychographic segment received specific messaging and responses were
electronically sent back to the ancillary staff. Overall response rate to text, email or voice
messaging was 87.5%. When responses were positive no further call back was necessary thus
freeing up staff to assist other patients. However, if any negative response including pain control,
mobility or wound issues, those patients received an immediate call back. The 30-day readmission
rate during this pilot study was 1.45%.

Discussion/Conclusion: This study is unique in that we utilized consumer industry techniques and
applied to specific lumbar spine patients. We have found that the psychographic segmentation tool
is useful for engagement of patients and classified them per attitudes and beliefs. The pilot
program has provided insights for deployment of medical resources to support patients and
activate positive health behavior.

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Paper 35

Preoperative Mental Health May Not Be Predictive of Improvements in Patient Reported
Outcomes Following a Minimally Invasive Transforaminal Lumbar Interbody Fusion

Fady Hijji, BS1, Ankur Narain, BA1, Benjamin Mayo, BA2, Dustin Massel, BS2, Daniel Bohl, MD, MPH3,
Kelly Yom, BA1, Krishna Kudaravalli, BS1, Kern Singh, MD2
1
, Chicago, IL, 2Rush University Medical Center, Chicago, IL, 3Rush University Medical Center, New
Haven, CT

Background/Introduction: Prior literature has associated poor preoperative mental health with
inferior patient-reported outcomes following spinal procedures. The purpose of this study is to test
for an association of preoperative Short Form-12 (SF-12) Mental Health Composite Score (MCS)
with improvements in Oswestry Disability Index (ODI) and back and leg pain following a minimally
invasive transforaminal lumbar interbody fusion (MIS TLIF).

Materials/Methods: A retrospective analysis of patients who underwent a primary, one-level MIS
TLIF was reviewed. Patients were excluded if they did not have complete patient-reported outcome
data for the preoperative or all postoperative visits. Preoperative SF-12 MCS was tested for
association with preoperative ODI, back Visual Analog Scale (VAS), and leg VAS. Preoperative MCS
was then tested for association with changes in ODI, back and leg VAS from the preoperative to
postoperative visits. These tests were conducted using multivariate regression controlling for
baseline characteristics as well as for the preoperative score for the patient-reported outcome
being assessed.

Results: A total of 71 patients were included in the analysis. At baseline, higher preoperative MCS
was associated with lower preoperative ODI (Coefficient: -0.62, p<0.001), preoperative back VAS (-
0.07, p=0.003), and preoperative leg VAS (-0.06, p=0.019). However, there was no association
between preoperative MCS and improvement in ODI, back VAS, or leg VAS at any of the
postoperative time points (p>0.05 for each). The percent of patients achieving a minimum clinically
important difference at 6 months did not differ between the bottom and top MCS quartiles (p>0.05
for each).

Discussion/Conclusion: The results of this study suggest that better preoperative mental health is
associated with lower perceived preoperative disability and with increased severity of preoperative
back and leg pain. In contrast to other studies, the present study was unable to demonstrate that
preoperative mental health is predictive of improvement in patient reported outcomes at any
postoperative time point following an MIS TLIF.

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Paper 36

Validation and Utility of the Patient Reported Outcomes Measurement Information System
(PROMIS®) in Patients with Lumbar Stenosis with or without Spondylolisthesis

Hemil Maniar, MD1, Wellington Hsu, M.D.2, Surabhi Bhatt, BS3, Jason Savage, M.D.4, Alpesh Patel,
MD, FACS3
1
Geisinger Health Systems, Coal Township, Pennsylvania, 2Northwestern Memorial Hospital,
Chicago, Illinois, 3Northwestern University, Chicago, IL, 4The Cleveland Clinic, Cleveland, Ohio

Background/Introduction: Lumbar stenosis is a clinical syndrome caused by narrowing of the spinal
canal characterized by back and leg pain. A subset of patients with lumbar stenosis have
spondylolisthesis. Surgical decompression with laminectomy is a current standard of care with
good outcomes, however, there is controversy regarding the results in patients with concomitant
spondylolisthesis. Patient reported outcomes used in studies comparing these surgical procedures
utilize legacy measures including but not limited to ODI (Ostwestry Disability Index), VAS (Visual
Analog Scale), ZCQ (Zurich Claudication Questionnaire), SF -12 (short form) etc., that are,
administered on paper forms, time consuming, inaccurate and have floor/ceiling effects. PROMIS
was created to improve on these limitations and uses a computer adaptive testing (CAT) model.

Materials/Methods: 69 patients with lumbar stenosis were included in this prospective study.
Patients were administered outcomes questionnaires - PROMIS (pain behavior, pain interference,
physical function) and legacy measures (ODI, ZCQ, SF-12) preoperatively, 6 weeks and 3 months
post-operatively. Patients were divided into two groups depending on presence or absence of
spondylolisthesis. Patients with spondylolisthesis were treated with an instrumented fusion in
addition to laminectomy.

Results: 39 patients had spondylolisthesis, 30 had lumbar stenosis without spondylolisthesis. At
baseline, both groups were comparable with no statistical difference between PROMIS scores and
legacy measures. Patients with spondylolisthesis had slightly poorer scores at baseline and this
difference was maintained at all times. Both subsets of patients improved substantially at 3 month
follow up. Change in scores in legacy measures was also comparable to PROMIS in both groups.

Discussion/Conclusion: Our study validates the utilization of PROMIS in lumbar spinal stenosis
patients with or without spondylolisthesis. Longer term followup is needed to compare the results
of treatment.

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Paper 37

An Analysis of Conflicts of Interest in Lumbar Spine Surgery: The Effects of Industry Payments on
Practice Patterns and Complication Rates

Gurmit Singh, BS1, Ralph Cook, BS2, Joseph Weiner, BS3, Michael Schallmo, BS3, Danielle Chun, MD2,
Sameer Singh, BS2, Kathryn Barth, BS2, Alpesh Patel, MD, FACS4, Wellington Hsu, M.D.5
1
, Chicago, IL, 2Northwestern University Department of Orthopaedic Surgery, Chicago, IL,
3
Northwestern University Department of Orthopaedic Surgery, Chicago , IL, 4Northwestern

Background/Introduction: Conflict of interest (COI) in medicine poses a potential threat to the
quality of patient care and safety. Previous studies identified that orthopaedic and neurological
surgeons receive among the highest payment amounts from the industry. With the recent
increases in spine fusions and discrepancies regarding the surgical management of degenerative
disc disease, a surgeon’s decision to pursue lumbar fusion as a therapeutic option could be affected
by the surgeon’s financial interests. In this study, we aimed to determine whether financial
relationships with industry have any impact on the practice patterns of spine surgeons or the
complication rates for spine fusion.

Materials/Methods: A database of 2,110 orthopaedic (54%) and neurological spine (46%) surgeons
with corresponding lumbar fusion recommendation rates, complication rates, and industry
payments was compiled. Practice pattern data was derived from a publically available Medicare-
based database, which included the total number of, and rate at which each spine surgeon
recommended fusion from 2011-2012. Complication rates for each surgeon from 2009-2013 were
extracted from the ProPublica Surgeon Scorecard database. A mixed-effects model adjusting for
age and health-status of the patient along with hospital mortality and surgeon random-effects was
used to risk-adjust each surgeon’s raw complication rate. Data regarding industry payments from
2013-2014 were derived from the Open Payments website. Surgeons’ performing fewer than 10
fusions from 2011-2012 and those without complications data were excluded. Pearson correlation
coefficients and multivariate regression analyses were used to determine the relationship between
industry payments, lumbar fusion recommendation rates, and complication rates.

Results: Pearson correlation analyses revealed a negligible relationship between the industry
payments and lumbar fusion recommendation rates (r = 0.07; p<0.01) (Figure 1). Multivariate
regression analysis demonstrated no significant relationships among the industry payments, and
lumbar recommendation or complication rates. Additionally, a comparison of 2007 surgeons
receiving payments from the industry and 103 surgeons with undisclosed payments revealed no
significant differences between fusion recommendations or complication rates the two groups.

Discussion/Conclusion: While spine surgeons receive the highest industry payment amounts
among all subspecialties, conflict of interest does not appear to have a significant impact on the
surgeons’ practice patterns or complication rates.

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93
Paper 38

Hospital Competitive Intensity Predicts Perioperative Outcomes Following Lumbar Spinal Fusion

Wesley Durand, ScB1, Joseph Johnson, ScB (2018)2, Neill Li, BS, MD3, JaeWon Yang, BA1, Adam
Eltorai, BA4, J. Mason DePasse, MD5, Alan Daniels, MD6
1
Brown University, Warren Alpert Medical School, Providence, RI, 2Brown University, Providence,
RI, 3Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence,
RI, 4Warren Alpert Medical School of Brown University, Providence, RI, 5Department of
Orthopaedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island,
6
Department of Orthopaedics, Division of Spine Surgery- Adult Spinal Deformity Service, Warren
Alpert Medical School of Brown University, Providence, Rhode Island

Background/Introduction: Increased hospital competition may improve health care delivery and
outcomes. We investigated whether the level of local hospital competition affects perioperative
lumbar spinal fusion outcomes.

Materials/Methods: Patients undergoing lumbar spinal fusion from the Nationwide Inpatient
Sample from 2003, 2006, and 2009 were analyzed. The Herfindahl-Hirschman Index (HHI), a
validated measure of a market’s competitive intensity, was utilized to assess county-level hospital
market competitiveness. Total charges were adjusted for inflation to 2015 dollars using the Bureau
of Labor Statistics Consumer Price Index. Multivariate regression was performed to adjust for
confounding variables, including: patient age, gender, primary payer, severity score, primary vs.
revision fusion, national region, hospital bed size, location/teaching status, ownership, and year.
Statistical significance set at p<0.05, a priori.

Results: In total, 59,743 patients underwent lumbar spinal fusion and had county HHI data and
were included in the analysis. After adjusting for confounding variables with multivariate
regression, increased competitive intensity (as measured by county HHI) was associated with
increased total complication rate (i.e., any complication) (OR=1.49 for county HHI=0 vs. county
HHI=1, p=0.0016), increased total charges (ratio=1.39, p=0.0025), and increased hospital length of
stay (LOS) (ratio=1.23, p<0.0001). No significant relationship was observed between HHI and
inpatient mortality (OR=0.82, p=0.6495). Analysis of complication subtype revealed an association
between increased competitive intensity and increased odds of gastrointestinal complication
(OR=2.02, p=0.0338), infection (OR=3.28, p=0.0005), and neurologic complications (OR=2.09,
p=0.0050).

Discussion/Conclusion: This investigation revealed an association between increased competitive
intensity among hospitals and increased odds of complications, increased total charges, and
prolonged LOS following lumbar spinal fusion. The cause of this disparity is unknown, however,
highly competitive hospital markets may contain hospitals which provide relatively lower quality
care due to suboptimal resource availability. Perioperative outcome disparities between highly
competitive and minimally competitive geographies should be monitored and further studied.

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Paper 39

Discriminative Ability of Commonly Used Comorbidity Indices: A Comparison of ASA, the
modified Charlson Comorbidity Index, and the modified Frailty Index

Nathaniel Ondeck, B.S.1, Daniel Bohl, MD, MPH2, Patawut Bovonratwet, BS3, Ryan McLynn, B.S.4,
Jonathan Cui, B.S.4, Blake Shultz, B.A.4, Adam Lukasiewicz, MSc3, Jonathan Grauer, MD1
1
, New Haven, CT, 2Rush University Medical Center, New Haven, CT, 3Yale School of Medicine,
New Haven, CT, 4Yale School of Medicine, New Haven, Connecticut

Background/Introduction: As research tools, ASA, the modified Charlson Comorbidity Index (mCC),
and the modified Frailty Index (mFI) have been associated with adverse outcomes following spine
procedures. However, as clinical measures, no known study has compared their predictive
performance. The purpose of the present study is to compare the discriminative ability of ASA,
mCCI, and mFI as well as demographic factors for peri-operative adverse outcomes following
posterior lumbar fusion.

Materials/Methods: Patients undergoing posterior lumbar fusion were extracted from National
Surgical Quality Improvement Program (NSQIP) database 2011-2014. The discriminative ability of
the ASA, mCCI, and mFI as well as demographic factors for general-health adverse outcomes were
assessed using area under the curve (AUC) analyses from receiver operating characteristics curves.

Results: When considering comorbidity indices, ASA was equivalent to mFI for predicting any
adverse event, severe adverse events, minor adverse events and discharge to higher-level care.
ASA performed better than mFI for discrimination of an extended hospital length of stay.
Regardless of outcome variable, the mCCI was the worst comorbid index for predicting adverse
outcomes. When considering demographic factors, age alone had the statistically significantly
largest AUC for 4 out of 5 adverse events (any adverse event, minor adverse events, extended
length of stay and discharge to higher level care). Age and BMI were equally discriminative for the
occurrence of severe adverse events. A comparison of the most predictive demographic factor
(age) and comorbidity index (ASA) resulted in age having the larger discriminative ability for 3 out
of the 5 adverse events and ASA being more predictive for 1 out of 5 adverse events (Table 1). A
combination of the most predictive demographic factor and comorbidity index, resulted in
improvements in discriminative ability over the individual components for 4 out of the 5 outcome
variables.

Discussion/Conclusion: For posterior lumbar fusion, ASA (a comorbidity index based upon
physician gestalt) performed as well or better than formulaic indices (mCCI and mFI) for predicting
peri-operative adverse outcomes. Patient age was the most powerful demographic predictor of
adverse outcomes. In summary, easily obtained patient characteristics such as ASA and age have
similar to better discriminative abilities than complex numerically tabulated indices.

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Paper 40

Comparative Effectiveness between Primary and Revision Foraminotomy for the Treatment of
Lumbar Foraminal Stenosis

Emily Hu, BA1, Jianning Shao, B.A.2, Heath Gould, B.S.3, Roy Xiao, B.A.2, Colin Haines, M.D.4, Don
Moore, MD5, Thomas Mroz, M.D.6, Michael Steinmetz, MD7
1
Case Western Reserve University School of Medicine, Cleveland, Ohio, 2, Cleveland, OH, 3, North
Las Vegas, Nevada, 4, Reston, Virginia, 5Cleveland Clinic, Norwalk, OH, 6Cleveland Clinic
Foundation, Neurological Institute, Cleveland, OH, 7Cleveland Clinic, Department of Neurosurgery
, Cleveland, OH

Background/Introduction: Foraminotomy has demonstrated clinical benefit for the management
of lumbar foraminal stenosis. Although a substantial number of patients undergo more than one
foraminotomy procedure, there is little data comparing primary foraminotomy (PF) and revision
foraminotomy (RF) in terms of cost and quality of life (QOL) outcomes.

Materials/Methods: A retrospective cohort study was conducted among patients undergoing
foraminotomy for the treatment of lumbar foraminal stenosis. QOL instruments (EQ-5D, PDQ, and
PHQ-9) were prospectively collected between 2008 and 2016. The primary outcome measure was
improvement in postoperative QOL. Secondary outcome measures included perioperative cost and
QOL minimum clinically important difference (MCID).

Results: 703 procedures were eligible for study inclusion – 580 (83%) PF and 123 (17%) RF. There
were no significant differences in demographics between the PF and RF groups. Preoperatively,
mean EQ-5D index (0.542 vs. 0.503, p=0.15), total PDQ (78.9 vs. 84.1, p=0.20), and total PHQ-9
(7.95 vs. 9.05, p=0.22) demonstrated marginally greater QOL in the PF cohort compared to the RF
cohort. Postoperatively, EQ-5D index showed significant improvement in both the PF
(0.542→0.636, p<0.0001) and the RF (0.503→0.645, p<0.0001) cohorts. Similarly, total PHQ-9
improved significantly in the PF cohort (7.95→5.99, p<0.001) and in the RF cohort (9.05→6.17,
p<0.01). Total PDQ, however, showed a significant improvement only in the PF cohort (78.9→64.0,
p<0.0001) and failed to reach significance in the RF cohort (84.1→72.5, p=0.14). QOL scores were
also compared between groups preoperatively and postoperatively. The only significant difference
between PF and RF was observed in postoperative PDQ score (64.0 vs. 72.5, p=0.03). Similarly, the
proportion of patients achieving an MCID on the PDQ instrument was significantly greater in PF
compared to RF (44% vs. 24%, p=0.03). Finally, perioperative cost did not differ significantly
between cohorts (PF: $62,386 vs. RF: $68,300, p=0.26).

Discussion/Conclusion: Marginally poorer preoperative QOL was observed among patients
undergoing RF compared to PF. PF yielded a statistically greater degree of improvement in total
PDQ score and PDQ MCID compared to RF. PF therefore appeared to be more cost-effective
relative to RF, since PF was associated with a lower perioperative cost but a significantly greater
QOL improvement as measured by the PDQ instrument.

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99
Paper 41

Decompression Versus Fusion for Grade I Degenerative Spondylolisthesis: A Meta-Analysis

Scott Koenig, BS1, Julio Juaregui, MD1; Mark Shasti, MD1, Luke Brown, MD2, Steven Ludwig, MD2, Daniel Gelb,
MD2, Kelley Banagan, MD2, Eugene Koh, MD, PhD2
1
University of Maryland Medical Center, Baltimore, Maryland, 2, Baltimore, MD

Background/Introduction: Degenerative spondylolisthesis (DS) remains one of the most common
indications for spine surgery. Although large trials supported surgical treatment for this pathology and
recent meta-analysis has compared different fusion techniques, the best surgical option for patients with
only grade 1 disease has not been determined. The purpose of this study is to compare decompression and
fusion with decompression alone for the treatment of grade 1 DS.

Materials/Methods: The MEDLINE, Embase, and Ovid electronic databases were systematically reviewed for
studies evaluating patients with grade 1 DS published from January 1996 until July 2016. We stratified
patients into two cohorts; the first group underwent a decompressive-type surgery and the second cohort
underwent a fusion procedure. We looked at clinical outcomes, complications, reoperations, and surgical
details such as blood loss. Descriptive statistics were used to describe both cohorts; then, random effect
models were used to determine the rates of the specified outcome metrics, with its 95% confidence
intervals.

Results: A total of 17 studies met our criteria. Nine studies (N=591 patients) who were part of the
decompression cohort, with a mean age of 67 years, mean BMI of 24 kg/m2, and 54% were women. The
fusion cohort had 14 studies (N=434 patients) with a mean age mean 60 years, mean BMI of 24 kg/m2 and
71% were female. In both cohorts, the pain (leg and low back) significantly decreased, the physical
component of the Short Form 36 (SF-36), and overall increased the outcome metric scales. The
decompression cohort had a 7.5% complication rate (95% CI of 2 to 16%) and the fusion had a 9.2%
complication rate. In contrast, the reoperation rate was higher in the decompression cohort with a 6% rate
than in the fusion cohort with a 4.4% rate.

Discussion/Conclusion: Patients undergoing decompression alone tended to be older and had a higher
percentage of leg pain while fusion patients tended to be younger and have more low back pain. The
decompression cohort had fewer complications but a higher revision rate. Future studies specifically
assessing patients with low grade DS are needed to determine the benefits and cost effectiveness of one
procedure versus another.

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101
Paper 42

Effect of Lumbar Fusion on Adjacent Segment Disc Deformation: an In-Vivo Pre and Post-Fusion
Surgery Patient Analysis

Thomas Cha, MD, MBA1, Kamran Khan, MS2, Yan Yu, MD, PhD3, Kirkham Wood, MD4, Guoan Li,
PhD5
1
MGH, Boston, MA, 2Harvard Medical School/Massachusetts General Hospital , Boston, MA,
3
HMS/MGH, Boston, Ma, 4, Redwood City, CA, 5Massachusetts General Hospital , Boston,
Massachusetts

Background/Introduction: Up to 80% of patients develop adjacent segment degeneration (ASD) as
early as one year after lumbar fusion, with 17-36% of patients requiring re-operation due to
symptomatic ASD within 5-10 years. Kinematic changes at the adjacent segment after a spinal
fusion have been assumed to be a causing factor for ASD, yet clear evidence is lacking. This study
investigated adjacent segment disc deformation under weight bearing conditions before and after
lumbar fusion surgeries.

Materials/Methods: Ten patients with disk degenerative disease at L4-S1 were MRI scanned and
3D anatomical models were constructed for each. Subjects were then imaged using a dual
fluoroscopic imaging system at standing, flexion and extension positions before undergoing a
fusion surgery at the L4-S1 segments. Five patients were imaged again 3 years after undergoing
fusion surgery for post-op analysis. Deformations of the adjacent disc of L3-4 were calculated using
the changes in geometry between the endplates of L3 and L4 segments, using the MRI disc as the
reference. Patient data was compared with 8 healthy control subjects.

Results: Our data shows that a fusion surgery significantly increases tensile and shear deformations
on the adjacent disc. Post-fusion, the disc height was reduced by 1.15mm, on average. On average,
13%, 15%, and 12% increase in shearing deformation was observed during standing, flexion and
extension positions, respectively, after a fusion surgery. Lastly, greater tensile deformations were
observed at flexion and extension positions post-op when compared to pre-op and normal control
subjects. Specifically, on average, an increase in 9% compressive and 10% tensile deformations at
flexion position, 15% in compressive and 7% in tensile deformations at extension position were
observed.

Discussion/Conclusion: This study indicates that a fusion surgery increases the tensile and shear
deformations at the adjacent disc. The data reveals that post-fusion, the anterior position of the
disc experiences greater stresses than other positions. These increased stresses lead to disc
deformations and degeneration of the adjacent segment discs. As fusion surgery can lead to ASD, it
should be limited to when dynamic biomechanical and clinical evidence of instability is present to
minimize reoperation rate.

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103

FOUNDED 2008

Rapid Fire

ABSTRACTS

104

RF Paper 01

The Effectiveness of Bioskills Module for Simulated Lumbar Pedicle Screw Instrumentation

Sohaib Hashmi, MD1, Barrett Boody, M.D.2, Joseph Maslak, M.D.3, Michael McCarthy, MD4, Alpesh
Patel, MD, FACS5, Wellington Hsu, M.D.6
1
Northwestern University , Chicago, Il, 2Northwestern Memorial Hospital, Chicago, illinois,
3
Northwestern University - Feinberg School of Medicine, Chicago, Il, 4, Chicago , Il, 5Northwestern

Background/Introduction: To develop an inexpensive, user-friendly, and reproducible lumbar
pedicle screw instrumentation bioskills training module and evaluation protocol that can be readily
implemented into residency training progra1ms to augment the clinical education of orthopaedic
and neurosurgical physicians-in-training.

Materials/Methods: 19 participants comprised of senior medical students and orthopaedic surgical
residents. Participants were randomized to control (n=9) or intervention (n=10) groups controlling
for level of experience (medical students, junior resident, or senior resident). The intervention
group underwent a 20-minute bioskills training module while the control group spent the same
time with self-directed study. Pre- and post-test performance was self-reported by each participant
(Physician Performance Diagnostic inventory scale, PPDIS). Total number of pedicle breaches were
calculated pre- and post- test. Objective outcome scores were obtained from a blinded fellowship-
trained attending orthopaedic spine surgeon using Objective Structured Assessment of Technical
Skills (OSATS) and Objective Pedicle Instrumentation Score metrics. In addition, identification of
pedicle breach and breach anatomic location was measured pre- and post-test in lumbar spine
models.

Results: When compared to the control group, the intervention group had fewer breaches on post-
test pedicle instrumentation (p=0.013). While the improvement in OSATS (p = 0.247) was not
significant, there was mean improvement in PPDIS (p= .033475.) scores in the intervention group.
There was no statistically significant improvement in identification of pedicle breach or anatomic
location of breach in both the control and experimental groups.

Discussion/Conclusion: We conclude that a concise lumbar pedicle screw instrumentation bioskills
training session can be a useful educational tool to augment clinical education. Although no direct
clinical correlation can be concluded from this study, the improvement in trainee’s technical and
procedural skills suggests that Sawbones training modules can be an efficient and effective tool for
teaching fundamental spine surgical skills outside of the operating room.

105
RF Paper 02

Resident Involvement as a Risk Factor in Anterior Lumbar Fusion Outcomes

Samantha Jacobs, BA1, William Ranson, BS2, Chierika Ukogu, BA2, Jun Kim, MD2, John Di Capua,
MHS, BS3, Sulaiman Somani, BS3, Luilly Vargas, BSN3, Samuel Cho, MD4
1
, New York, New York, 2, New York, NY, 3Icahn School of Medicine at Mount Sinai, New York,
New York, 4, NY, NY

Background/Introduction: Introduction: Anterior lumbar fusion (ALF) procedures are indicated in
adult degenerative lumbar disorders and spondylolisthesis. Residents simultaneously serve as both
doctor and student. This study seeks to characterize resident involvement as a risk factor for 30-
day postoperative outcomes following elective anterior lumbar fusions.

Materials/Methods: Methods: This was a retrospective analysis of American College of Surgeons
National Surgical Quality Improvement Program (ACS-NSQIP) database between 2011 and 2014 for
patients undergoing ALF. Patients with age <18 years, non-elective surgery, emergency surgery,
current pneumonia, current sepsis, current pregnancy, wound class >1 or a previous operation
within 30 days of the principal operation were excluded from the study. Two cohorts were created
of patients whose surgeries were performed only by an attending and those who were performed
by an attending and a resident. Multivariate logistic regression models were employed, adjusting
for patient demographics, preoperative and intraoperative variables, to identify outcomes
impacted by resident involvement.

Results: Results: 340 ALF patients met the inclusion criteria for the study and 71.8 % of patients
underwent surgeries performed solely by an attending. Multivariate logistic revealed the absence
of a resident to be a predictor for decreased incidence of any major complication (OR=0.40, 0.23-
0.70, p-value=0.0013, c-statistic=0.768), decreased incidences of length of stays ≥ 5 days (OR=0.29,
0.16-0.50, c-statistic=0.698), and decreased incidence of intra/postoperative transfusion (OR=0.24,
0.11-0.51, p-value=0.0002, c-statistic=0.822). Major complications are defined as wound,
pulmonary, cardiac and renal complications, venous thromboembolism, urinary tract infections,
intra/postoperative transfusions, length of stays ≥ 5 days, reoperation, unplanned readmission and
mortality. P-values are <0.001 unless noted otherwise.

Discussion/Conclusion: Conclusion: The presence of a resident is a predictor for postoperative
complications including length of stays longer than 5 days and intra/postoperative transfusions in
ALF patients.
106

107
RF Paper 03

Assessing Online Patient Education Readability for Spine Surgery Procedures

Ankur Narain, BA1, Fady Hijji, BS1, William Long, BA2, Krishna Modi, BS2, Dustin Massel, BS2,
Benjamin Mayo, BA2, Kern Singh, MD2
1
, Chicago, IL, 2Rush University Medical Center, Chicago, IL

Background/Introduction: Increased patient reliance on Internet-based health information has
amplified the need for comprehensible online patient education articles. As suggested by the
American Medical Association (AMA) and National Institute of Health (NIH), spine fusion articles
should be between a 4th and 6th grade readability level to increase patient comprehension, which
may contribute to improved postoperative outcomes. The purpose of this study is to determine the
average readability level of online healthcare education information relating to lumbar fusion and
anterior cervical discectomy and fusion (ACDF) procedures.

Materials/Methods: Three popular search engines were utilized to access patient education
articles for common cervical and lumbar spine procedures. Relevant articles were analyzed for
readability using Readability Studio Professional Edition software (Oleander Software, Ltd). Articles
were stratified by organization type as follows: General Medical Websites (GMW), Healthcare
Network/Academic Institutions (HNAI), and Private Practices (PP). Thirteen common readability
tests were performed with the mean grade level for each readability test compared between
subgroups using analysis of variance (ANOVA) testing.

Results: Lumbar fusion and ACDF articles were determined to have a mean readability level of 11.3
± 1.6 and 10.7 ± 1.5, respectively. GMW, HNAI, and PP subgroups had mean readability levels of
10.9 ± 3.0, 10.8 ± 2.9, and 11.6 ± 2.7 for lumbar fusion and 10.9 ± 2.9, 10.7 ± 2.8, and 10.7 ± 2.5 for
ACDF articles. Of 310 total articles, only 6 (3 lumbar fusion and 3 ACDF) were written below the 7th
grade reading level.

Discussion/Conclusion: Current online literature from medical websites containing information
regarding lumbar fusion and ACDF procedures are written at a grade level higher than the
suggested guidelines. Therefore, current patient education articles should be revised to
accommodate the average readability level in the United States and may result in improved patient
comprehension and postoperative outcomes.

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109
RF Paper 04

Is Physical Therapy Helpful After Lumbar Spine Surgery? A Multivariate Analysis of 1130 Patients

Ananth Eleswarapu, M.D.1, Srikanth Divi, M.D.2, Lewis Shi, MD2, Douglas Dirschl, M.D.1, James Mok,
M.D.1, Christopher Stout, Ph.D.3, Michael Lee, M.D.1
1
University of Chicago Medical Center, Chicago, IL, 2, Chicago, IL, 3ATI Physical Therapy,
Bolingbrook, IL

Background/Introduction: There is conflicting evidence in the literature as to whether PT is helpful
in patients recovering from lumbar spine surgery. There is no existing treatment algorithm to guide
surgeons as to which patients should be referred for PT, when therapy should begin, and how long
patients should undergo therapy.

Materials/Methods: 1130 patients who underwent PT following lumbar spine surgery were
included. Pre- and post-PT scores on Oswestry Disability Index (ODI), activity Numeric Pain Rating
Scale (NPRS) and resting NPRS were recorded. Logistic regression was used to identify risk factors
associated with failure to reach the minimal clinical important difference (MCID). For each
timepoint, patients referred to PT were compared to those who had not yet undergone PT to
correct for the natural improvement in clinical outcome scores following surgery.

Results: The percentage of patients meeting the MCID for improvement following PT in ODI,
activity NPRS, and resting NPRS was 32.1%, 55.0%, and 53.8% respectively. Workers’ compensation
status and the presence of nighttime symptoms were found to be associated with increased odds
of failure to meet MCID for improvement for all three clinical outcomes. A non-significant trend
was seen towards improved final outcomes in patients who began therapy in the first 20 days after
surgery. When analyzing patients who finished at the same timepoint, an increased number of PT
visits was associated with improved clinical outcomes.

Discussion/Conclusion: We conclude that in appropriately selected patients following lumbar spine
surgery, post-operative PT is associated with improved clinical outcomes.

110

111
RF Paper 05

What Are the Differences in Medicare DRG Reimbursement for MIS Deformity Surgery in
Academic vs Private Hospitals in Different Geographic Regions?

Pierce Nunley, MD1, Gregory Mundis, M.D., 2, Robert Eastlack, M.D., 3; Dean Chou, MD4, Christopher
Shaffrey, MD5, Praveen Mummaneni, MD6, International Spine Study Group (ISSG), -7
1
Spine Institute of Louisiana, Shreveport, Louisiana, 2San Diego Spine Foundation , San Diego ,
California, 3Scripps Clinic, La Jolla , California , 4University of California, San Francisco, San
Francisco, California, 5University of Virginia Medical Center, Charlottesville, VA, 6, San Francisco,
California, 7, Littleton, Colorado

Background/Introduction: While physicians are reimbursed based on CPT coding, hospitals are
reimbursed based on Diagnosis Related Group (DRG) codes. This coding does not differentiate
between number of levels fused but is impacted by approach (ant/post v ant or post only). The aim
of this study is to investigate the impact of both geographic location and practice setting on
reimbursement.

Materials/Methods: DRG based reimbursement for anterior, posterior and circumferential 1 or
more level fusions for deformity at 12 institutions was collected. The reimbursement data was then
categorized into academic (AC) vs private (PV) and urban (UR) vs suburban (SU) hospitals. The DRG
was selected based off of coding for a deformity surgery.

Results: There were 3 PV and 9 AC practices’ data available for review. AC reimbursement was
$45,353 while PV was $29,585 (p=0.019). If significant CC were present AC received $59,541 and
$39,281 for PV (p=0.022). With a major complication (MCC) reimbursement increased to $78,188
AC and $52,014 PV (p=0.024). There were 8 UR and 4 RU sites identified. In the UR setting,
reimbursement was $44,270 and $35,672 (p=0.21) for RU. With CC the UR sites received $58,182
and RU $47,063 (p=0.21). With a MCC, UR received $76,455 and UR $62,024 (p=0.22). When
comparing AC-UR (n=7) to PV-RU (n=2) the cost is 62% higher ($28,530 vs $46066). When
comparing a 3 vs 8 day stay no significant changes in reimbursement occurred. A hospital stay of 8
days vs 3 days increased reimbursement by $355/day for AC and $61/day for PV.

Discussion/Conclusion: Medicare DRG based reimbursement was highest for urban academic
institutions. Private suburban hospitals must be more efficient to offset this reimbursement
inequity. The number of levels fused and the length of hospital stay has minimal impact on DRG
based reimbursement regardless of costs

112

113
RF Paper 06

Prevalence of Pre-Operative Lower Urinary Tract Symptoms Among Patients Undergoing Elective
Lumbar Spine Surgery

Elizabeth Lieberman, MD1, Stephanie Radoslovich, BA1, Ryan Boone, BS1, Valentina Haj, BS1, Jayme
Hiratzka, MD2, Lynn Marshall, Sc.D.3, Jung Yoo, MD1
1
Oregon Health and Science University, Portland, Oregon, 2Oregon Health & Science University,
Portland, Oregon, 3Oregon Health and Science University, Portland, OR

Background/Introduction: Lower urinary tract symptoms (LUTS) are common in the adult
population. Prevalence of LUTS is greater among adults with back pain compared to the adult
population. However, LUTS prevalence and risk factors among patients undergoing elective lumbar
spine surgery is unknown.

Materials/Methods: In this study, we used a validated questionnaire, the International Prostate
Symptom Score (IPSS), to determine LUTS severity among elective lumbar spine surgery patients
from 9/2015 to 9/2016 at Oregon Health and Science University. Data collected included IPSS
scores and pre-operative clinic notes. Prevalence of moderate/severe LUTS, defined as IPSS score
8-35 points. The 95% confidence intervals (CI) for LUTS prevalence were estimated using the
normal approximation method for binomial parameters in Microsoft Excel. We compared LUTS
prevalence in the study sample to prevalence estimates in the general population from the Boston
Area Community Health Survey (BACH).

Results: Survey data was obtained from 81% of eligible patients. The sample included 259 patients
(123 men, 136 women). No patients in the sample had cauda equina syndrome. Of these, 50% (95%
CI: 42%, 58%) of women and 39% (95% CI: 30%, 48%) of men had moderate/severe LUTS. These
prevalence estimates substantially exceed those of 19% of women and 19% of men observed in the
BACH survey. The BACH survey included subjects ages 30-79 years. Therefore we repeated the
analyses after restricting our sample to ages 30-79 years. The prevalence estimates of
moderate/severe LUTS were essentially unchanged at 50% of women and 40% of men. The
prevalence of moderate/severe LUTS was highest (56%) for patients with spondylolisthesis, in the
middle (51%) for patients with stenosis, and lowest (34%) for patients with herniated nucleus
pulposus.

Discussion/Conclusion: Although none of the patients had cauda equina syndrome,
moderate/severe LUTS were highly prevalent in this population. In this sample of patients there is
evidence to suggest that age, sex and diagnosis may influence these symptoms. Further analysis
looking at medication use, psychological distress, quantification of sacral root compression, and
eventually the ability to provide relief from these symptoms will augment this study’s findings.

114
RF Paper 07

Risk of Surgical Site Infection and Mortality Following Lumbar Fusion Surgery in patients with
Chronic Steroid Usage and Chronic Methicillin Resistant Staphylococcus Aureus (MRSA) infection

RABIA QURESHI, BS1, DENNIS CHEN, MD2, ALI NOURBAKHSH, MD3, Hamid Hassanzadeh, MD4,
Adam Shimer, MD4, Francis Shen, MD5; Anuj Singla, MD5
1
, CHARLOTTESVILLE, VA, 2University of Virginia Healthsystem, Charlottesville, VA, 3, Columbia,
MO, 4, Charlottesville, VA, 5, Charlottesville, Virginia

Background/Introduction: Systemic immunosuppression by chronic steroid use and chronic MRSA
infection carriers may pose an increased risk of SSI. Their association with SSI and mortality in
posterior lumbar fusion surgery has not been studied in detail. Our study sought to determine the
effects of chronic steroid use and chronic MRSA infection on rates of SSI and mortality in patients
65 years of age and older who were treated with posterior lumbar spine fusion.

Materials/Methods: A retrospective analysis was performed using an insurance based private
database (PearlDiver database) to identify patients over 65 years of age who had undergone 1-2
level posterior lumbar spine fusion from 2005 to 2012. Study cohorts were created for patients
who had been taking oral glucocorticoids chronically and those with a history of chronic MRSA
infection amongst the fusion patients. The rates of 90 day surgical site infection (SSI) in these two
mutually exclusive cohorts were compared to an age- and risk-factor matched control cohort and
odds ratio was calculated.

Results: A total of 360,005 patients were identified to have 1-2 level lumbar fusion with chronic
steroid usage and MRSA infection in 11,687 and 5,899 respectively. Chronic oral steroid use was
significantly associated with increased risk of 1 year mortality (OR=2.06, 95%CI 1.13-3.78 p=0.018)
and trended toward significantly increased risk of SSI at 90 days (OR=1.74, 95%CI 1.33-1.92
p<0.001) and 1 year (OR=1.88, (95%CI 1.41-2.01 p<0.001). Chronic MRSA infection was significantly
associated with increased risk of SSI at 90 days (OR=6.99, 995%CI 5.61-9.91 p<0.001) and 1 year
(OR=24.0, 95%CI 22.20-28.46 p<0.001) but did not significantly impact mortality

Discussion/Conclusion: In patients 65 years of age and older who underwent elective posterior
lumbar fusion, our study found chronic oral steroid therapy to be associated with increased risk of
1 year mortality but not SSI, while chronic MRSA infection was associated with increased risk of SSI
at both 90 and 1 year, but not 1 year mortality. These two risk factors should be important
considerations during the perioperative period and may play a role in patient selection as well as
preoperative planning and risk stratification.

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116
RF Paper 08

The Risk of Postoperative Surgical Site Infection Following Lumbar Spine Surgery after Exposure
to Steroids at the Time of Surgical Intervention

Louis Jenis, MD1, Benjamin Cowan, BA2
1
Massachusetts General Hospital, Boston, MA, 2, Boston, MA

Background/Introduction: Intraoperative corticosteroids are commonly used during lumbar spine
surgery to potentially alleviate postoperative pain and limit autonomic reaction to general
anesthesia. The efficacy of intraoperative steroid administration (topical or systemic) and any
association with surgical site infections (SSI) remains controversial. The goal of this study was to
evaluate the risk of postoperative SSI following lumbar spine surgery after exposure to steroids at
the time of surgical intervention and whether there is a beneficial effect of steroids on
postoperative length of hospital stay.

Materials/Methods: Retrospective review of patients who had surgery for degenerative lumbar
spine disease at a single tertiary care center between 2005 and 2015. Inclusion criteria - lumbar
spine surgery patients in this timeframe who had a postoperative SSI within 90 days that required a
surgical intervention. The intraoperative steroids administered were classified as intravenous or
topical after chart review. Demographic data, steroid administration and dosage, surgical details,
and other patient characteristics were evaluated.

Results: Of the 1116 subjects who fit inclusion criteria, 79 patients had a SSI necessitating
reoperation within 90 days while 1037 patients did not. 96 (8.60%) subjects were given
intraoperative topical steroids (TS), while 276 (24.73%) subjects were given intraoperative
intravenous steroids (IVS). 10 (10.42%) patients in the TS group had an SSI, while 69 (6.75%)
patients in the non-TS group had a SSI. While the TS group had a higher rate of infection than the
non-TS group, this difference was not statistically significant (p = .208, odds ratio: 1.6, 95% CI: .797 -
3.22). Additionally, 19 (6.88%) patients in the IVS group had a SSI, while 60 (7.14%) in the non-IVS
group had a SSI. This difference was not statistically significant either (p = 1.000, odds ratio: .961,
95% CI: .563 – 1.64). Additionally, patients had shorter postoperative hospital stays in both the TS
group (p < .001) and the IVS group (p=.0043) compared to patients who did not receive steroids.

Discussion/Conclusion: This study demonstrates no association between topical or intravenous
intraoperative steroid administration and infection. In addition, we found that patients receiving
topical steroids or intravenous steroids had shorter postoperative hospital stays.

117
RF Paper 09

Associations between Preoperative Hyponatremia and Perioperative Complications in Lumbar
Spinal Fusion

Thomas Bomberger, BA1, Joseph Tanenbaum, BS2, Daniel Lubelski, M.D.3, Michael Steinmetz, MD4,
Edward Benzel, M.D.5, Thomas Mroz, M.D.5
1
, Cleveleand Heights, OH, 2Case Western Reserve University School of Medicine, Cleveland, Ohio,
3
Johns Hopkins Hospital, Baltimore, MD, 4Cleveland Clinic, Department of Neurosurgery ,
Cleveland, OH, 5Cleveland Clinic Foundation, Neurological Institute, Cleveland, OH

Background/Introduction: Several studies of surgical cohorts have identified preoperative
hyponatremia as an important risk factor for poor perioperative outcomes. However, this
relationship has not been studied in lumbar spinal fusion patients. The purpose of this study is to
investigate whether preoperative hyponatremia is a risk factor for 30-day major morbidity and
mortality, increased hospital length of stay, and 30-day readmission and reoperation rates in
patients undergoing lumbar fusion.

Materials/Methods: We used validated CPT codes for lumbar fusion to identify patients in the
American College of Surgeons' NSQIP database, and identified hyponatremic ([Na]<135mEq/L) and
normonatremic ([Na] 135-145mEq/L) groups. We then performed a baseline univariate analysis to
identify potentially predictive covariates (surgical approach and setting, patient demographics, and
comorbidities) for each outcome. Missing data was addressed using a multiple imputation
technique. Finally, multivariate logistic regression was used to identify significant associations
between hyponatremia and several outcome measures, when compared to the normonatremic
group.

Results: We identified 10,654 lumbar spinal fusion patients who were either hyponatremic or
normonatremic. Multivariable analysis showed that preoperative hyponatremia was independently
associated with major morbidity and mortality (OR 1.21; 95%CI 1.03-1.43), major morbidity (OR
1.22; 95%CI 1.03-1.44), and longer hospital length of stay (OR 1.14; 95%CI 1.02-1.27). However, we
did not identify a statistically significant association between preoperative hyponatremia and
mortality, 30-day readmission or 30-day reoperation.

Discussion/Conclusion: The present multi-institution study found that preoperative hyponatremia
was independently associated with an increased risk of poor perioperative outcomes after
controlling for numerous confounding covariates. As the U.S. transitions to a value and quality-
based healthcare model, quantifying the association between modifiable risk factors and adverse
outcomes has become increasingly important. The results of the present study can improve patient
selection and preoperative risk counseling for lumbar spinal fusion operations, leading to improved
healthcare delivery.

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RF Paper 10

Thirty-Day Complications of Navigated Versus Conventional Single-Level Instrumented Posterior
Lumbar Fusion: An ACS-NSQIP Analysis

Patawut Bovonratwet, BS1, Stephen Nelson, MD2, Nathaniel Ondeck, B.S.3, Benjamin Geddes, MD1,
Jonathan Grauer, MD3
1
Yale School of Medicine, New Haven, CT, 2Yale University School of Medicine, New Haven, CT, 3,
New Haven, CT

Background/Introduction: After the first navigated pedicle screw was implanted in 1995, the use of
navigation in spinal instrumentation has slowly but steadily increased. The touted advantages of
navigated surgery include better placement of pedicle screws and lower radiation exposure to the
surgeon. Although multiple studies have investigated the accuracy of pedicle screw placement and
radiation exposure with the use of navigation, no study has compared perioperative complications
between navigated and conventional posterior lumbar fusion. The primary purpose of the current
study was to compare perioperative outcomes between navigated and conventional single-level
instrumented posterior lumbar fusion.

Materials/Methods: Patients who underwent navigated or conventional single-level instrumented
posterior lumbar fusion in the 2010-2015 American College of Surgeons National Surgical Quality
Improvement Database (NSQIP) were identified based on CPT codes. Patient characteristics and
comorbidities were compared between the navigated and conventional cohorts. The usage of
navigation throughout the years was characterized. Propensity score matched comparisons were
performed for, operative time, hospital length of stay, thirty-day postoperative adverse events, and
thirty-day readmissions between the navigated and conventional cohorts.

Results: Navigated cases have increased over time to be approximately 10% of reported posterior
lumbar fusions in the NSQIP database. After propensity matching to control potential confounding
factors, statistical analysis revealed no significant difference for most adverse events, including
wound infection, return to the operating room, and readmission. There were significantly lower
blood transfusions in the navigated cohort (2.84% versus 7.15%). Operative time was not different
between the two cohorts. Patients who underwent navigated surgery did have a shorter mean
hospital length of stay (0.2 day difference). Although this is statistically significant, it is probably not
clinically significant.

Discussion/Conclusion: There are potential benefits of navigation such as better pedicle screw
placement and reduced surgeon radiation exposure. The reduced blood loss and mildly reduced
hospital length of stay identified for the navigated cases are probably markers of more minimally
invasive surgery in the navigated cohort. The current study could not identify other differences
such as wound infection (of concern due to bulky navigation technology) or return to the operating
room (a potential functional difference in outcome).

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120
RF Paper 11

The Prevalence of Spinal Epidural Lipomatosis On Magnetic Resonance Imaging

Nina Theyskens, MD1, Nuno Paulino Pereira, MD2, Stein Janssen, MD3; Thomas Cha, MD, MBA3, Joseph
Schwab, MD, MS3
1
, Boston , Massachusetts , 2, Boston , Massachusetts, 3MGH, Boston, MA

Background/Introduction: Spinal epidural lipomatosis (SEL) refers to an excessive accumulation of fat within
the epidural space. It can be idiopathic or secondary, resulting in significant morbidity. The prevalence of
SEL, including idiopathic and secondary SEL, and its respective risk factors are poorly defined. We therefore
sought to: (1) assess the prevalence of SEL among patients who underwent a dedicated Magnetic Resonance
Imaging (MRI) scan of the spine –including: incidental SEL (i.e. SEL without any spine-related symptoms), SEL
with spine-related symptoms, and symptomatic SEL (i.e. with symptoms specific for SEL), and (2) assess
factors associated with overall SEL and subgroups. In addition, we assessed differences between SEL
subgroups.

Materials/Methods: We retrospectively reviewed the records of 28,902 patients, aged 18 years and older
with a spine MRI (2004 to 2015) at two tertiary care centers. Prevalence numbers were calculated as a
percentage of the total number of patients. We used multivariate logistic regression analysis to identify
factors associated with overall SEL and subgroups.

Results: The prevalence of overall SEL was 2.5% (731/28,902): incidental SEL 0.6% (168/28,902), SEL with
symptoms 1.8% (526/28,902), and symptomatic SEL 0.1% (37/28,902). Factors associated with overall SEL in
multivariate analysis were: higher age (OR: 1.02 95%CI: 1.01 – 1.02, p < 0.001), higher Modified Charlson
Comorbidity Index (OR: 1.07, 95%CI: 1.03 – 1.11, p < 0.001), male sex (OR: 2.30, 95%CI: 1.85 – 2.87, p <
0.001), BMI 25-29.9 (OR: 2.28, 95%CI: 1.50 – 3.46, p < 0.001), BMI > 30 (OR: 7.45, 95%CI: 5.07 – 11.0, p <
0.001), Black/African American race (OR: 1.59, 95%CI: 1.06 – 2.36, p = 0.023), systemic corticosteroid use
(OR: 3.26, 95%CI: 1.99 – 5.36, p < 0.001), and epidural corticosteroid injections (OR: 3.69, 95%CI: 2.77 – 4.90,
p < 0.001).

Discussion/Conclusion: We found that about 1 in 40 patients undergoing a spine MRI had SEL; 23% of whom
with no symptoms, 72% with spine-related symptoms, and 5% with symptoms specific for SEL. Our data help
identify patients that might warrant an increased index of suspicion for SEL.

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RF Paper 12

Validating The Clinical Significance of The CARDS Classification For Degenerative Spondylolisthesis
Through Preoperative Outcome Measures

Rasheed Abiola, MD1, Jason Ferrel, MD1, Nicholas Spina, MD1, W. Ryan Spiker, MD2, Brandon Lawrence, MD2,
Darrel Brodke, MD2
1
University of Utah, Salt Lake City, Utah, 2, Salt Lake City, Utah

Background/Introduction: The CARDS classification divides degenerative spondylolisthesis (DS) into 4
distinct groups using radiographic criteria of disc collapse, less than 5mm of translation, greater than 5mm
of translation and segmental kyphosis. Though studies have shown reliability and reproducibility as a
classification system, no study has looked at the 4 distinct CARDS group and how they vary in pain, physical
function or disability. The purpose of this study is to classify patients with DS using the CARDS classification
and compare the preoperative outcome measures between CARDS groups.

Materials/Methods: A retrospective review was done with all patients with the diagnosis of degenerative
spondylolisthesis at a single level in the lumbar spine seen between October, 2013 and November, 2016.
Multilevel surgery, prior laminectomy, prior discectomy, or scoliotic curve greater than 15 degrees were
excluded, as were patients without preoperative outcome scores. The patients were divided into the
CARDS classification groups. Preoperative PF CAT scores, ODI, VAS leg and back were reviewed and
analyzed.

Results: From a total of 744 patients with DS, 102 met the inclusion and exclusion criteria. 20 (20%)
patients had Type A, 39 (38%) patients had Type B, 40 (39%) had Type C, and 3 (3%) patients had Type D.
Trend towards lower PF CAT score, higher VAS leg and higher VAS back in Type D, though not statistically
different overall among CARDS groups (p=0.3343, p=0.3881 and p=0.3836 respectively). No difference in
ODI score (p=0.5892) among different CARDS classification groups.

Discussion/Conclusion: CARDS classification is a reliable method for classifying DS. Measuring by PF CAT,
ODI, VAS leg and back, neither disc space collapse (Type A), greater or less than 5mm of translation (Type B
and C), nor kyphotic angulation (Type D) had a significant effect on patient presentation in DS. Trends
however show that DS patient with segmental kyphosis (Type D) have lower PF CAT scores and higher VAS
leg and back scores. Future studies will look at the clinical course, treatment received and subgroup analysis
of each CARDS subtype.

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RF Paper 13

Utility of Supine Lateral Radiographs in Assessment of Lumbar Segmental Instability in
Degenerative Lumbar Spondylolisthesis

Foster Chen, MD1; Sandip Tarpada, BA2, Woojin cho, MD, PhD3
1
Montefiore Medical Center, Orthopedic Surgery, Bronx, New York, 2Albert Einstein College of
Medicine, Bronx, New York, 3Montefiore Medical Center, Bronx, New York

Background/Introduction: The accurate evaluation of segmental instability is critical to the
management of lumbar spondylolisthesis. Standing flexion-extension lateral radiographs are
routinely obtained, as it is believed to precipitate the forward-backward motion of the segment;
however recent studies with MRI and CT have shown that the relaxed supine position can facilitate
the reduction of the anterolisthesed segment. Here, we show that inclusion of supine lateral
radiographs likewise increases the amount of segmental instability seen in single-level lumbar
spondylolisthesis when compared to traditional standing neutral/flexion/extension lateral
radiographs.

Materials/Methods: Supine lateral radiographs were added to the routine evaluation (standing
neutral/flexion/extension lateral radiographs) of symptomatic spondylolisthesis at our institution.
In this retrospective study, 66 patients with this series of radiographs were included. The amount
of listhesis was measured and compared on each radiograph: Standing neutral lateral (“neutral”),
Standing flexion lateral (“flexion”), Standing extension lateral ( “extension”), and Supine lateral
(“supine”).

Results: 66 patients (56 female, 10 male), with a mean age of 60.9 years (+/- 11.8 years) were
included in this study. The mean mobility seen with flexion-extension was 5.57%. The mean
mobility seen with flexion-supine was 8.13%. This difference was significant in paired t-test
(p<0.001), and independent of age and BMI. The maximal mobility was seen between flexion and
supine radiographs in 40 patients, between neutral and supine radiographs in 14 cases, and
between traditional flexion-extension studies in only 11 cases.

Discussion/Conclusion: The supine radiograph demonstrates more reduction in anterolisthesis
than the extension radiograph. The supine radiograph is technically easy for both the facility and
for patient comfort, and can be a valuable tool in the evaluation of spondylolisthesis. It is much less
expensive than MRI or CT. This study suggests that the incorporation of a supine lateral radiograph,
and possible replacement of the extension radiograph, can improve our understanding of
segmental mobility when evaluating instability in a spondylolisthesis patient.

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124
RF Paper 14

2-5 Year Follow Up on S2AI Pelvic Fixation

Evan Smith, MD1, Justin Kyhos, MD2, Robert Dolitsky, MD3, Warren Yu, MD4; Joseph O’Brien, MD, MPH5
1
George Washington University, Washington, DC, 2Northwestern University, Chicago, Illinois, 3Northwell
Health, Long Branch, NJ, 4George Washington University Department of Orthopaedic Surgery,
Washington, DC, 5, Rockville, MD

Background/Introduction: Sacropelvic fixation continues to be a challenge when performing long fusions to
the pelvis. S2 alar-iliac (S2AI) screws have been found to provide solid biomechanical fixation and have been
found to have good clinical results in short term follow up for pediatric and adult patients. However, longer
follow up has yet to be presented. We have an established population and aim to report our results from 2
to 5 years post-operatively.

Materials/Methods: Cases were retrospectively reviewed at one institution in patients who had placement
of S2AI screws for long fusions with at least a 2 year follow up. Demographic data as well as fusion,
complications and reoperations were reviewed. Complications were broken into minor and major categories
similar to previous series on sacropelvic fixation.

Results: There were 86 cases identified with at least 2 year follow up after S2AI fixation. Minor
complications occurred in 32.6% of the study population with the majority being intraoperative dural tears.
Major complications occurred in 19.8% of patients. These included primarily proximal junctional kyphosis
and adjacent segment degeneration. Revision surgery for all causes was performed in 23% of the cohort.
The rate of fusion at L5-S1 for patients without preoperative pseudarthrosis was 95.3%. Preoperative L5-S1
pseudoarthrosis was identified in 20 patients as an indication for surgery. Of these patients, 17 went on to
fusion after one surgery, all went on to fusion after two surgeries. There was evidence of screw lucency in
10.4% of cases. However, the majority of these were asymptomayic. One patient had persistent SI pain,
three patients had evidence of pseudarthrosis requiring revision surgery.

Discussion/Conclusion: Sacropelvic fixation using the S2AI technique provides safe,durable fixation with low
rates of technique specific complications and limited need for hardware removal. Complication rates in this
series were similar to other series on long fusions to the pelvis. Additionally, fusion rates were high at L5-S1
for both patients with and without preoperative L5-S1 pseudarthrosis. It appears that the S2AI technique is a
powerful option for patients with previous L5-S1 pseudarthrosis.

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126
RF Paper 15

Radiographic Analysis of Psoas Morphology and its Association with Neurovascular Structures at
L4-5

Philip Louie, MD1; Ankur Narain, BA2, Fady Hijji, BS2, Alem Yacob, MD2, Bryce Basques, MD1, Kelly
Yom, BA2, Frank Phillips, MD2, Kern Singh, MD1
1
Rush University Medical Center, Chicago, IL, 2, Chicago, IL

Background/Introduction: The direct lateral transpsoas approach, lateral lumbar interbody fusion
(LLIF) procedures at the L4-5 level carry a significant risk of injury to the lumbar plexus. Previous
small case series have introduced descriptions of anatomical psoas muscle variants that may
indicate a greater risk of neurovascular injury during LLIF procedures. The objective of the present
study was to utilize high-resolution magnetic resonance imaging (MRI) to expand the anatomical
description of psoas morphology and its association with the neurovascular structures at the L4-5
intervertebral level.

Materials/Methods: Axial L4-5 sections of consecutive patients who obtained lumbar MRIs were
analyzed. Teardrop psoas morphology was assessed qualitatively. MRI described psoas morphology
and proximity of neurovascular structures, while plain radiographs were evaluated for lumbosacral
transitional vertebrae (LSTV). Teardrop morphology was tested for associations with radiographic
measurements using t-tests and chi-square analysis.

Results: 50 teardrop and 476 non-teardrop psoas muscles were identified. Teardrop morphology
was associated with greater longitudinal length (53.1 vs. 49.3mm, p=0.012), and shorter transverse
length (34.9 vs. 44.8mm, p<0.001) compared to non-teardrop. Teardrop morphology was
associated with anterior and lateral migration of the psoas with greater distance between the
anterior borders of the psoas and disc (13.5 vs. 6.3mm, p<0.001), and greater distance between the
medial border of the psoas to the lateral disc border (1.6 vs 0.5mm, p<0.001). Teardrop
morphology was associated with a higher incidence of the lumbar plexus migrating anteriorly
adjacent to the middle-third of the disc (43.4% vs. 17.6%, p<0.001) and the iliac vasculature located
adjacent to the anterior-third of the disc (43.4% vs. 30.0%, p=0.047). Teardrop morphology was not
associated with presence of LSTV (3.8% vs 7.6%, p=0.306).

Discussion/Conclusion: The results of this study suggest that psoas muscles with teardrop
morphology are more anteriorly and laterally displaced from the L4-5 disc space than normal psoas
muscles. Furthermore, the lumbar plexus is more anteriorly displaced and the iliac vasculature is
more posteriorly displaced from the L4-5 disc space in the presence of teardrop morphology. As
such, the risk of intraoperative neurovascular injury during LLIF may be elevated in the setting of
teardrop morphology at the L4-5 intervertebral level.

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128
RF Paper 16

National Trends in the Utilization of Vertebroplasty and Kyphoplasty Procedures throughout the
United States

Joseph Laratta, MD1; Nathan Hardy, BS1, Jamal Shillingford, MD1, Joseph Lombardi, MD1, James Lin,
MD, MS2, Comron Saifi, MD3, Andrew Pugely, MD1, Charla Fischer, MD4, Lawrence Lenke, MD1,
Ronald Lehman, MD5
1
, New York, NY, 2Columbia University Medical Center, New York, NY, 3Midwest Orthopedics at
Rush, Chicago, IL, 4Columbia University Department of Orthopaedic Surgery, New York City, New
York, 5, New York, NY

Background/Introduction: Double-blinded prospective randomized controlled trials have shown no
benefit to the use of vertebroplasty over a sham procedure in the treatment of vertebral fractures.
Contrastingly, kyphoplasty may be beneficial when appropriately indicated. Our group
hypothesized that the use of vertebroplasty for vertebral fractures had decreased over the past
decade, while the use of kyphoplasty remained relatively constant.

Materials/Methods: The National Inpatient Sample (NIS) database was queried for patients who
underwent either kyphoplasty (ICD-9-CM 81.66) or vertebroplasty (ICD-9-CM 81.65) procedures
between 2004 and 2014 across 44 states. Demographic and economic data were obtained which
included the annual number of surgeries, age, sex, insurance type, location, and frequency of
routine discharge. The NIS database represents a 20% sample of discharges from U.S. hospitals,
excluding rehabilitation and long-term acute care hospitals, which is weighted to provide national
estimates.

Results: In 2014, an estimated total number of 24,250 kyphoplasty and 6,615 vertebroplasty were
performed across the United States. The number of vertebroplasty procedures has decreased 51%
from 16,970 in 2008. Similarly, the number of kyphoplasty procedures has decreased 45% from
44,324 in 2007. Based on payer, Medicare patients comprised 81% of those billed for kyphoplasty
and vertebroplasty, and 75% of procedures were utilized in areas designated as not low income. In
2014, patients in the South Atlantic region comprised 23% of vertebroplasty and 27% of
kyphoplasty cases, far more than any other region. Additionally, kyphoplasty and vertebroplasty
were more often performed in teaching facilities rather than community hospitals (61% and 68%,
respectively).

Discussion/Conclusion: Since the publication of two double-blinded, prospective randomized
controlled trials not showing any benefit of vertebroplasty over a sham procedure, there has been
a significant decrease in both kyphoplasty and vertebroplasty procedures.

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130
RF Paper 17

A Retrospective Study of Thoracolumbar Burst Fractures Treated with Fixation and Non-fusion
Surgery of Intra-vertebral Bone Graft Assisted with Balloon Kyphoplasty

Chengmin Zhang, PhD1; Paul Arnold, MD1, Qiang Zhou, MD2
1
, Kansas City, KS, 2Southwest Hospital, Third Military Medical University, Chongqing, China

Background/Introduction: Thoracolumbar fractures are common spinal injuries. Posterior fixation
and fusion is the primary treatment, although this may sacrifice range of motion (ROM) to achieve
stability, rather than treating the fracture itself. Two issues addressed when treating
thoracolumbar fractures include: 1) replacing the fractured vertebrae, especially the upper
endplate of the injured vertebrae, and 2) provide strong fixation with biomechanical stability and
flexibility.

Materials/Methods: This retrospective study included 75 consecutive patients with thoracic or
lumbar fractures treated from October 2010 to May 2014. A total of 61 patients met inclusion
criteria. Patients were divided into one of two groups: group A, intra-vertebral bone graft with
balloon kyphoplasty (non-fusion surgery); and group B, traditional posterior fixation and fusion
surgery. The Visual Analog Scale (VAS) was done preoperatively as well as at three months, one
year, and two years. X-ray, CT, and MRI were done preoperatively. X-rays were done
postoperatively at three months and two years. Postoperatively at 3 months, CT was used to
confirm healing of the vertebral fracture.

Results: Patient demographics and baseline characteristics were similar in the two groups. All
fractures in both groups were reduced successfully, deformity was improved, and the more than
90% of anterior vertebral height (AHR) was restored. After removal of hardware in group A, ROM at
the injury level recovered (mean ROM 8.57°), and at 2 years, there was no loss of vertebral height
or recurrence of deformity. There was no hardware failure in group A, but there was evidence of
screw loosening three screws in group B.

Discussion/Conclusion: Non-fusion treatment of intra-vertebral bone graft assisted with balloon
kyphoplasty demonstrated good fracture reduction, deformity correction, fracture healing, and
ROM maintenance. There were no complications associated with the implant. With the continued
development of surgical techniques and materials, we believe that an increasing number of spinal
fracture patients can avoid spinal fusion.

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RF Paper 18

Radiographic Evaluation of Percutaneous Pedicle Screw Constructs Including Minimally Invasive
Facet Fusions for Unstable Spinal Column Injuries

Daniel Cavanaugh, MD, Tristan Weir, BS, Kelley Banagan, MD, Eugene Koh, MD, PhD, Daniel Gelb,
MD; Steven Ludwig, MD, Luke Brown, MD
, Baltimore, MD

Background/Introduction: The purpose of this study is to compare the maintenance of correction
of unstable, operative spine fractures that underwent percutaneous fixation with and without facet
fusion. A secondary outcome was to critically evaluate the hardware constructs for loosening and
failure during a short-term follow-up period.

Materials/Methods: We conducted a retrospective review of all operative thoracic and lumbar
spine fractures using our billing and coding database from 2006 to 2013. One-hundred and forty-
one cases were obtained. Fifty-five cases were excluded for lack of post-operative radiographs and
comorbidities. Eighty-seven had radiographs and operative reports available for review.
Maintenance of correction was the primary outcome. One-week postoperative radiographs and
available follow-up radiographs were analyzed for the Cobb angle to evaluate for progressive
kyphosis and loss of correction. We also examined each radiograph for instrumentation fracture,
loosening (greater than 2 mm radiolucency around any screw), or screw pullout.

Results: The mean follow-up of for all patients was 33 weeks. There average amount of kyphotic
progression was 3.2 degrees. There were no cases of instrumentation fracture during this follow-op
period. The rate of screw loosening was 24%. There was no significant difference in the rate of
loosening or progression of kyphosis in patients with facet fusion (with or without bone
morphogenetic protein [BMP]) and without facet fusion. There was no difference in the percentage
of screw pullout between groups. A total of 19 patients (22%) eventually underwent
instrumentation removal, of which, only 2 constructs were loose (10.5%).

Discussion/Conclusion: We did not demonstrate a significant difference in the progression of
kyphosis postoperatively between patients with and without facet fusion. Additionally, no
difference in kyphotic progression was noted when facet fusions were performed with or without
BMP. In thoracic and lumbar spinal column injuries, where percutaneous fixation is indicated, the
addition of facet fusion may be superfluous. Interestingly, we found a significantly higher rate of
screw loosening (24%) than previously reported for percutaneous cases, but loosening was not
significantly different between fused and non-fused groups. The clinical significance of this
instrumentation loosening remains unclear, as only 2 of 19 instrumentation removals had
loosening, and further clinical follow-up is needed.

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RF Paper 19

Clinical and Radiographic Analysis of Expandable versus Static Lateral Lumbar Interbody Fusion
Devices with One-Year Follow-up

Joseph O’Brien, MD, MPH1, Daina Brooks, Bachelor of Science2, Ingrid Luna, MPH3, Gita Joshua,
MA4, Richard Frisch, MD5
1
, Rockville, MD, 2, Audubon , PA, 3Globus Medical, Audubon, PA, 4Globus Medical, Audubon,
Pennsylvania, 5, Mt Pleasant, SC

Background/Introduction: Use of static and expandable interbody spacers for minimally invasive
lateral lumbar interbody fusion (LLIF) is widely accepted and offers favorable clinical results.
However, complications such as implant migration and/or subsidence may occur if optimal
interbody fit is unable to be obtained with a static implant. Expandable spacers allow in situ
expansion to optimize fit and mitigate iatrogenic endplate damage during trialing and impaction.
This study sought to compare clinical and radiographic outcomes of static and expandable
interbody spacers following LLIF and report device-related complications.

Materials/Methods: This multicenter clinical study included 25 patients (31 levels) who underwent
LLIF with a static spacer and 25 (29 levels) with an expandable spacer manufactured from titanium
alloy and radiolucent polyether-ether-ketone; all procedures were combined with supplemental
transpedicular posterior stabilization. Patient self-assessment forms and radiographic records were
used to assess clinical and radiologic outcomes.

Results: Mean patient age was 62.3 ± 10.8 years (62% female). Eighty percent of patients
underwent one-level surgery, and 20% two-level surgery. Results showed no significant differences
in estimated blood loss or length of hospital stay. However, operative time differed statistically
between static (66.8 ± 35.1 min) and expandable (112.1 ± 58.8 min) groups (P<0.01). Mean visual
analog scale (VAS) and Oswestry Disability Index (ODI) scores improved significantly from
preoperative to 12-month follow-up in both groups (P<0.05). Mean intervertebral disc height (±SD)
increased significantly from 8.8 ± 2.7 mm preoperatively to 15.4 ± 2.5 mm at 12 months for static
cages, and from 7.8 ± 2.3 mm preoperatively to 13.3 ± 2.5 mm at 12 months for expandable cages
(P < 0.01). Neuroforaminal height also increased significantly from preoperative to 12-month
assessment (P < 0.01). Fusion was observed in 96.3% (26/27) and 88.9% (16/18) of levels in static
and expandable spacer groups, respectively. Subsidence was reported in 21.4% (6/28) of static and
3.7% (1/27) of expandable levels (P<0.01). Postoperative radiographs showed no evidence of
implant migration, and no cases required surgical revision at index or adjacent levels.

Discussion/Conclusion: LLIF using expandable spacers resulted in similar clinical and radiographic
outcomes when compared with LLIF using static spacers and led to decreased subsidence.

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135
RF Paper 20

National Treatment Trends and Perioperative Outcomes of Surgical Options for Degenerative
Spondylolisthesis: An ACS-NSQIP study with comparison to prior LSRS survey results

Patawut Bovonratwet, BS1, Matthew Webb, AB1, Nathaniel Ondeck, B.S.2, Jonathan Cui, B.S.3, Ryan McLynn,
B.S.3, Kadimcherla Praveen, MD4, David Kim, MD5, Jonathan Grauer, MD2
1
Yale School of Medicine, New Haven, CT, 2, New Haven, CT, 3Yale School of Medicine, New Haven,
Connecticut, 4, Jersey City, NJ, 5New England Baptist Hospital, Boston, MA

Background/Introduction: Surgical treatment for lumbar degenerative spondylolisthesis is common.
Although most surgeries are performed with fusion, there is not consensus as to which fusion technique is
best. The current study builds upon a Lumbar Spine Research Society (LSRS) survey on this topic for which
the results were reported at the 2016 LSRS annual meeting. The primary purpose of the current study was to
compare surgical practice patterns for degenerative lumbar spondylolisthesis utilized by spine surgeons at
LSRS and surgeons captured by American College of Surgeons National Surgical Quality Improvement
Program (NSQIP). The secondary purpose was to use NSQIP to compare perioperative outcomes of three
common posterior surgical options for this pathology: uninstrumented posterior fusion, instrumented
posterior fusion, and instrumented posterior fusion with interbody.

Materials/Methods: A survey was administered to surgeons who attended the LSRS meeting in 2014. Data
was extracted from ACS-NSQIP from 2005-2014 to characterize the same responses. The two data sets were
compared. Perioperative outcomes of those in the NSQIP posterior fusion sub-cohorts were characterized
and compared.

Results: Posterior surgical approaches reported by the LSRS survey, which was previously presented, were
similar to those captured by NSQIP, where 72% of those with degenerative spondylolisthesis were fused. Of
those that were fused 8% had an uninstrumented posterior fusion, 33% had an instrumented posterior
fusion, and 59% had an instrumented posterior fusion with interbody. On multivariate analysis controlling
for patient characteristics / comorbidities, there was no difference in risk of minor adverse events, serious
adverse events, any adverse events, readmission, or length of stay to the treatment options studied.

Discussion/Conclusion: We had been surprised by the high rate of fusions performed with interbody for the
diagnosis of lumbar degenerative spondylolisthesis in the prior LSRS survey. The national data, based on the
NSQIP, revealed similar trends. Nonetheless, the current study could not detect perioperative differences in
thirty-day outcomes between the techniques. These findings highlight that surgeon preference, patient
experience, cost benefit considerations, and longer-term outcomes have to be the measures by which
surgical technique is chosen for degenerative spondylolisthesis.

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137
RF Paper 21

Combined Treatment with High-Dose Parathyroid Hormone (PTH 1-34) and Low Dose Bone
Morphogenetic Protein 2 (BMP-2) in a Rabbit Spinal Fusion Model

Christina Holmes, PhD1, Benjamin Elder, MD, PhD2, Wataru Ishida, MD2, Sheng-Fu Lo, MD1, Maritza
Taylor, BA3, John Locke, _3; Timothy Witham, MD1
1
Johns Hopkins University School of Medicine, Baltimore, MD, 2Johns Hopkins University School of
Medicine, BALTIMORE, Maryland, 3, BALTIMORE, Maryland

Background/Introduction: Previously, we demonstrated that, while low-dose (10 μg/kg) of
parathyroid hormone (1–34) (PTH) yielded increased fusion mass volume in a rabbit model, it did
not improve biomechanical stiffness nor improve fusion when combined with BMP-2 (Lina et al,
Spine [Phila Pa 1976]. 2014; 39(5):347). However, research in rodent models has suggested that the
effects of PTH are dose-dependent (Ming et al, Spine [Phila. Pa. 1976]. 2012; 37(15): 1275). We
thus aim to evaluate whether increasing the dosage of PTH increases both the volume and
biomechanical stiffness of the resulting fusion masses and/or exhibits synergistic effects with low-
dose BMP-2 treatment.

Materials/Methods: Posterolateral intertransverse process lumbar spinal fusion surgery was
performed on 60 male New Zealand White rabbits, divided into six experimental groups: [1] iliac
crest autograft alone (n =10); [2] autograft + 20 μg/kg PTH (n = 10); [3] autograft + 40 μg/kg PTH (n
= 10); [4] BMP-2 alone (n = 10); [5] BMP-2 + 20 μg/kg PTH; and, [6] BMP-2 +40 μg/kg PTH. Fusion
was assessed 6 weeks post-surgery via manual palpation and volumetric CT analysis. Fusion mass
stiffness was evaluated via four-point bending nondestructive biomechanical testing.

Results: When autograft was used, rabbits receiving PTH displayed an increased rate of fusion via
manual palpation, with increasing doses yielding increased fusion mass volume as assessed via CT.
However, increased mechanical stiffness was only observed in the 20 μg/kg group. All groups
treated with BMP-2 fused. The highest dose of PTH in combination with BMP-2 yielded significantly
increased fusion mass volume compared to treatment with BMP-2 alone, however, no significant
differences in mechanical stiffness were observed.

Discussion/Conclusion: Treatment with PTH alone increased fusion rate and fusion mass volume in
a dose dependent manner, when autograft bone is employed. However, there may be an optimal
dose in the rabbit model, as significant increases in mechanical stiffness were only observed at a
dosage of 20 μg/kg. While the effects of BMP-2 on fusion dominate, a significant increase in fusion
mass volume at a dosage of 40 μg/kg over BMP-2 alone, suggests there may be some synergistic
effects.

138
RF Paper 22

Intradiscal Injection of Polymethyl-Methacrylate/Hyaluronic Acid in an Ovine Model of
Degenerative Disc Disease: Long-Term Disc Appearance on MRI

Arvin Wali, BA1, David Santiago-Dieppa, MD2, Reid Hoshide, MD3, Natalie Taylor, BS2, Gloria Lin,
PhD2, Nick Manesis, PhD2, William Taylor, MD3
1
University of California, San Diego - Neurosurgery, Fullerton, California, 2, La Jolla, California,
3
University of California, San Diego, La Jolla, California

Background/Introduction: Degenerative disc disease (DDD) has been implicated as one of the
pathophysiologic causes of chronic low back pain. Previous histopathologic and plain radiographic
ovine studies have demonstrated that intradiscal polymethyl-methacrylate with hyaluronic acid
(PMMA/HA) injection may interrupt an induced degenerative process and maintain intervertebral
disc height after injury. The purpose of this study was to describe the magnetic resonance imaging
(MRI) findings of treated versus untreated disc levels.

Materials/Methods: Two healthy, adult-aged, ovine subjects underwent a surgical exposure of five
consecutive lumbar discs (L1-L6). An induced injury was accomplished via a left anterolateral
annulotomy at 4 levels in each animal. Of the 4 injured discs, 2 underwent intradiscal injection of
100-300 microliters of PMMA/HA—this defined the treated/injured group. Two discs served as the
untreated/injured control in each subject. The last disc space that was exposed, but did not
undergo injury, served as the uninjured untreated control. On postoperative day 240, T1 and T2
weighted MRI sequences were obtained. An independent radiologist, blinded to the intervention,
reviewed each level using the Modic and Thompson scores.

Results: Each subject tolerated PMMA/HA injection without any neurologic complications. After
240 days, in-vivo MRI demonstrated less DDD among treated/injured disc levels compared to
injured/untreated levels (Figure 1). The untreated, uninjured disc levels had Modic scores of 2 at
each disc level and Thompson scores that ranged from 2-4. Modic Scores for treated, injured disc
levels were 0 for each disc level compared to scores ranging from 0 to 2.5 in untreated, injured
discs. Thompson scores for treated, injured discs ranged from 1-2 compared to 1-4 in untreated,
injured disc levels. These MRI findings suggest that PMMA/HA injection in injured intervertebral
discs may confer some degree of disc preservation when compared to untreated, injured discs.

Discussion/Conclusion: In this pilot study of ten total intervertebral discs in two ovine subjects, we
demonstrate the feasibility of PMMA/HA injection and observe a difference in the Modic and
Thompson scores between injured and uninjured discs. Our findings suggest that this treatment
may hold promise and that further research is warranted to establish the efficacy of PMMA/HA
injection for the treatment of DDD.

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140
RF Paper 23

Tissue Engineered Bone Graft with Hypertrophic Chondrocytes Prevents Fusion in an Athymic Rat
Model

Comron Saifi, MD1, Joseph Laratta, MD2, Jamal Shillingford, MD2, Jonathan Bernhard, PhD3, Petros
Petridis, BS, MS3, Samuel Robinson, BS3, Mark Weidenbaum, MD4, Ronald Lehman, MD5, Gordana
Vunjak-Novakovic, MS, PhD3, Lawrence Lenke, MD2
1
Midwest Orthopedics at Rush, Chicago, IL, 2, New York, NY, 3Columbia University, New York, NY,
4
Columbia University Medical Center, New York, NY, 5, New York, NY

Background/Introduction: Each year in the United States, over 200,000 spinal fusion surgeries are
performed requiring bone grafts and bone graft substitutes. The current gold standard for
posterolateral lumbar fusion is autogeneous iliac crest bone graft (ICBG), but harvesting of this
graft is associated with increased operative time and significant complications. Nonetheless, there
continues to be a high rate of pseudoarthrosis, particularly in long fusions and patients who smoke.
This study sought to assess the efficacy of utilizing tissue engineered bone as an alternative bone
graft source. We hypothesized that implantation of osteogenic cells cultured in a porous scaffold
would increase fusion rates in an athymic rat spinal fusion model.

Materials/Methods: Bone cores harvested from bovine juvenile wrists were sterilized and
decellularized for scaffold production. Human derived bone marrow mesenchymal stem cells
(BMSC) were obtained and verified by tri-differentiation testing. BMSCs were applied to dried
scaffolds at a concentration of 3 x 10^8 cells/mL. The seeded cores were expanded for six weeks in
medium, mimicking endochondral ossification to produce hypertrophic chondrocytes. Single-level
intertransverse fusions were performed at the L4-L5 level of 31 athymic rats. Fifteen rats were
implanted with the hypertrophic chondrocyte seeded scaffold and sixteen had scaffold alone. Half
of the study rats were sacrificed at 3 weeks and the other half at 6 weeks. Spinal fusion was
analyzed using 2D and 3D micro-CT reconstructions.

Results: At 3 weeks, none of the hypertrophic chondrocyte rats had partial or complete fusion,
while 62.5% of the control rats fused and another 12.5% had partial fusions (p=0.013). At 6 weeks,
none of the hypertrophic chondrocyte rats fused and 50% had partial fusions, while 87.5% of the
control rats fused (p=0.002). Manual palpation was of limited utility in determining fusion given
inconsistent inter-observer and intra-observer reliability.

Discussion/Conclusion: This study demonstrates that certain tissue engineered bone grafts may
actually prevent fusion in an athymic rat model. The hypertrophic chondrocyte scaffold used in this
study does not represent a promising cost-effective bone graft substitute that could be useful in
spine fusions.

141

142
RF Paper 24

The Role of Calcium Pyrophosphate Dihydrate Deposition in Postoperative Outcome of Lumbar
Spinal Stenosis Patients

Thanase Ariyawatkul, MD1, Panya Luksanapruska, MD2, Witchate Pichaisak, MD1, Cholavech
Chavasiri, MD1, Sirichai Wilartratsami, MD1, Visit Vamvanij, MD1
1
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Bangkok, 2Department of
Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Bangkoknoi, Bangkok

Background/Introduction: Calcium pyrophosphate (CPP) associated arthritis is one of the most
common types of arthritis. Induced inflammation and other related clinical outcomes in CPP
associated arthritis and clinical-related outcomes are well-studied in CPP-associated arthritis of the
appendicular joints. However, studies about spinal calcium pyrophosphate dehydrate deposition
(SCPPD) remain scarce. Association among surgical interventions, inflammation in SCPPD, and
clinical outcomes are not well-understood. The goal of the presented study is to investigate the
association among surgical intervention, clinical and quality of life (QoL) outcomes in patients who
underwent surgery for lumbar spinal stenosis (LSS) that had SCPPD versus LSS patients without
SCPPD.

Materials/Methods: A single-institution database was reviewed, identifying LSS patients that were
treated by posterior spinal surgery during the 2003 to 2011 study period. LSS patients were
categorized as having or not having SCPPD. Diagnosis of SCPPD was confirmed by histologic
identification. Clinical presentations and post-operative results were analyzed. Disability and QoL
were assessed by using Oswestry Disability Index (ODI) and Short Form- 36 Health Survey (SF-36).

Results: Thirty-four patients were enrolled, with 18 patients allocated to SCPPD group and 16
patients allocated to non-SCPPD group. Preoperative and postoperative pain scores were not
significantly different between groups (p=0.33 and p=0.48, respectively). Average ODI score in
SCPPD group was slightly higher than in non-SCPPD group preoperatively (57 vs. 51; p=0.33), but
was significantly lower postoperatively (15 vs. 43; p=0.01). Postoperative physical function, vitality,
and mental health of SCPPD patients were also significantly improved (p = 0.03, p=0.022, and
p=0.022, respectively).

Discussion/Conclusion: Surgical intervention resulted in good clinical outcomes in SCPPD patients.
According to our findings, total removal of CPP-involved tissue is not necessary. As such, surgery
should be performed as indicated according to clinical presentation without concern regarding
presence of CPPD.

143
RF Paper 25

Treatment of the Fractional Curve with Circumferential Minimally Invasive (cMIS) Interbody
versus Open Surgery: An Analysis of Surgical Outcomes

Dean Chou, MD1, Praveen Mummaneni, MD2; Pierce Nunley, MD3, Robert Eastlack, M.D., 4, Stacie
Nguyen, MPH5, Gregory Mundis, M.D., 6, International Spine Study Group (ISSG), -7
1
University of California, San Francisco, San Francisco, California, 2, San Francisco, California,
3
Spine Institute of Louisiana, Shreveport, Louisiana, 4Scripps Clinic, La Jolla , California , 5San
Diego Spine Foundation , San Diego , California , 6San Diego Spine Foundation , San Diego ,
California, 7, Littleton, Colorado

Background/Introduction: The fractional curve of adult scoliosis can cause significant
radiculopathy. We sought to evaluate the outcomes of patients whose fractional curves were
treated with either cMIS or open techniques.

Materials/Methods: A multicenter retrospective review of an adult spinal deformity database of
MIS and open surgically treated patients, with the following inclusion criteria: age>18 years with
fractional curves >10°, ≥ 3 levels of instrumentation, and one of the following: coronal Cobb angle
(CCA)>20°, PI-LL>10°,PT>20°, SVA >5cm

Results: 118 patients had their fractional curves treated, 79 open and 39 cMIS. The fractional
curves were similar pre-op (17 cMIS, 19.6 open) and post-op (7 cMIS, 8.1 open), but open had more
levels treated (12.1 vs 5.7). cMIS had greater reduction in VAS leg (6.4 to 1.8) than open (4.3 to
2.5). When propensity matched for levels treated (6.6 cMIS and 7.3 open), 40 patients had their
fractional curves treated with either cMIS (n=20) or with open (n=20) surgery. Both groups had
similar fractional curve correction (18⁰ in both groups before surgery, 6.9⁰ in cMIS and 8.5⁰ in open
after). cMIS patients had a smaller postoperative coronal Cobb angle (12.5⁰ vs 24.3⁰) and lower EBL
(809cc vs 2299cc). Open patients had a higher SVA change (-19.6 vs +13.2), more pelvic fixation
(55% vs 15%), and more direct posterior decompressions (80% vs 22.2%). Both groups had similar
pre-op leg pain (VAS leg 6.1 cMIS and 5.4 open) and similar postop leg (VAS leg 1.6 cMIS and 3.1
open). All cMIS patients had interbody grafts whereas 35% of open did. The cMIS and open patients
had similar reduction in leg pain (change VAS Leg -4.4 vs -2.2). There was no significant difference
in change of Cobb angle, PI-LL, LL, ODI or VAS Back.

Discussion/Conclusion: In the treatment of the fractional curve of adult scoliosis with magnitude
greater than 10 degrees, patients treated with cMIS achieved similar reduction in leg pain
compared to those treated in an open fashion, even though significantly fewer cMIS patients
underwent direct decompression of the fractional curve nerve roots.

144
RF Paper 26

Radiographic Sagittal Alignment in the Asymptomatic Elderly: What is Normal for Age?

David McConda, MD1, Susan Odum, PhD2, Todd Chapman, MD3; P. Brad Segebarth, MD4
1
OrthoCarolina Spine Center, Charlotte, NC, 2OrthoCarolina Research Institute, Charlotte, NC,
3
Washington University School of Medicine, St. Louis, MO, 4OrthoCarolina, Charlotte, NC

Background/Introduction: The purpose of this study is to define “age normal” sagittal vertical axis
(SVA) in asymptomatic individuals ranging 60 to 80 years in order to create an acceptable target for
postop realignment in these patients.

Materials/Methods: 135 volunteers completed the Oswestry disability index (ODI) and Veterans
Rand 12 (VR12) questionnaires and full-standing lateral radiographs were obtained. Patients were
stratified into age cohorts of 60, 65, 70, 75 and 80 years. The primary outcome measure was SVA
and several additional radiographic measures were recorded. Exclusion criteria included back pain
history requiring medical attention within previous year, prior spinal surgery, neuromuscular
condition, or compression fracture. Pearson correlations were used to evaluate associations.
Analysis of Variance was used to determine differences in alignment across age-groups. Kruskal-
Wallis tests were used to determine differences in patient reported outcomes across age-groups.

Results: All SVA measures were within normal range (<40mm). There was no overall significant
(p=0.1083) difference in mean SVA for the 60, 65, 70, 75 and 80 year age groups. There were
significant differences between age groups in L1-S1(p=0.0056), and SS(p=0.0113), with a weak
associations between age and alignment. The mean L1-were (57.32, 52.93, 53.4, 48.77, 45.39
degrees) for each respective age-group. Significant differences existed comparing 60 vs 75 year
age-groups (p=0.0382), and 60 vs 75 year age-groups (p=0.006). Mean SS values for the age-groups
were (39.18, 32.97, 34.33, 32.57, 32.17 degrees), respectively with significant differences between
the 60 vs 70 year age-groups (p=0.0354), the 60 vs 75 year age-groups (p=0.0194) and the 60 vs 80
year age-groups (p=0.0384). ODI and VR-12 scores were not significantly different between age
groups.

Discussion/Conclusion: In contrast to other studies, this study showed no statistically significant
difference in SVA between the age groups in asymptomatic elderly individuals. We found that
asymptomatic elderly individuals maintained a relatively normal SVA; however, full body
radiography may better demonstrate other compensatory mechanism accounting for this. The
need for restoration of normal sagittal alignment in the elderly population may still require further
investigation given the frequency and severity of complications inherent in this population.

145
RF Paper 27

Effect of Lumbosacral Fusion Alignment on the Biomechanics of the Proximal Lumbar Segments
in Standing and Sitting Postures

Avinash Patwardhan, PhD1, Saeed Khayatzadeh, PhD2, Antonio Faundez, MD3, Robert Havey, MS4,
Leonard Voronov, MD, PhD5, Alexander Ghanayem, MD6, Jean-Charles Le Huec, MD7
1
1. Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center,
Maywood, Illinois, USA, Hines, IL, 2Orthopedic Biomechanics Lab, Hines VA Hospital, Hines, IL, 33.
Division of Orthopaedic Surgery, Geneva University Hospitals, Meyrin, Switzerland, Meyrin, NA,
4
Orthopedic Biomechanics Lab Edward Hines Jr. VA Hospital, Hines, IL, 51. Department of
Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Hines, IL, 61.
Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center,
Maywood, IL, 7Orthopaedic Surgery, Bordeaux University Hospital, Bordeaux, NA

Background/Introduction: L4-Sacrum is the most prevalent site of spinal fusions for painful
degenerative conditions in adults. Lumbopelvic alignment in the standing posture is recommended
as the ideal fusion alignment to avoid postoperative complications; even though, adults are
spending increasing amount of time in sedentary activities involving sitting. In this study, we asked:
(1) how do different sitting postures alter the lumbosacral spinal alignment, and (2) what impact
will this have on the biomechanics of proximal lumbar segments adjacent to fusion?

Materials/Methods: Postural influence on lumbosacral sagittal alignment was assessed by
analyzing full-length radiographs of 11 asymptomatic volunteers taken in three postures: (i)
standing, (ii) erect-sitting, and (iii) slumped-sitting. For each subject, we calculated what would
happen to the alignment of the lumbar (L1-S1) spine, in the absence of compensation, in erect- and
slumped-sitting postures if the L4-S1 vertebrae were fixed to simulate L4-S1 fusion in the standing
alignment (Figure 1A,B,C). Finally, we calculated the change in L1-L4 alignment necessary if the
subject were to fully compensate to restore the L1 vertebra to its pre-fusion angular alignment
(Figure 1D,E). Calculations were also made for the second scenario where the simulated L4-S1
fusion was performed in the erect-sitting alignment.

Results: Transitioning from standing to erect-sitting decreased L4-S1 lordosis (29° to 17°, p<0.001)
and L1-L4 lordosis (18° to 16°). Transition from erect-sitting to slumped-sitting changed L4-S1
lordosis (17° to 13°) and L1-L4 from 16° lordosis to 2.5° kyphosis (p<0.001). Simulated L4-S1 fusion
in standing alignment required significantly greater flexion of L1-L4 to accommodate erect- and
slumped-sitting postures (13° and 36°). L4-S1 fusion performed in erect-sitting alignment
distributed the postural compensation of L1-L4. Erect sitting to standing and erect to slumped-
sitting required 13° extension and 23° flexion respectively.

Discussion/Conclusion: The increased demand on junctional segments to accommodate post-
fusion standing and sitting postures may contribute to their mechanical breakdown. Biomechanical
analysis suggests the importance of preoperatively assessing flexion-extension range of motion in
the patient’s upper (L1-L4) lumbar segments to arrive at a patient-specific decision regarding ideal
146
L4-S1 fusion alignment.

147
RF Paper 28

Utility of Intraoperative Rotational Thromboelastometry in Thoracolumbar Deformity Surgery

Jian Guan, MD, Meic Schmidt, MD, MBA, Andrew Dailey, MD
University of Utah, Salt Lake City, UT

Background/Introduction: Blood loss during surgery for thoracolumbar scoliosis often requires
blood product transfusion. Rotational thromboelastometry (ROTEM) has enabled more targeted
treatment of coagulopathy, but its use in deformity has received limited study. We investigated
whether the use of ROTEM reduces transfusion requirements in a case-control study of
thoracolumbar deformity surgery.

Materials/Methods: Data were prospectively collected on all patients receiving ROTEM-guided
blood product management during long-segment (7+ level) posterior thoracolumbar fusion
procedures at a single institution from April 2015 to February 2016. Patients were matched
according to age, fusion segments, number of osteotomies performed, and number of interbody
fusion levels with a group of historical controls that did not receive ROTEM-guided therapy.
Demographic, intraoperative, and postoperative transfusion requirements were collected on all
patients. Univariate analysis of ROTEM status and multiple linear regression analysis of factors
associated with total in-hospital transfusion volume were performed, with p<0.05 considered
significant.

Results: Fifteen patients who received ROTEM-guided therapy were identified and matched with
15 non-ROTEM controls. The mean number of fusion levels was 11 among all patients, with no
significant differences between groups in fusion levels, osteotomy levels, interbody fusion levels, or
other demographic factors. Patients in the non-ROTEM group required significantly more total
blood products during their hospitalization than patients in the ROTEM group (8.5±4.2 units versus
3.71±2.8 units, p=0.001). Multiple linear regression analysis showed that use of ROTEM (p=0.016)
and a lower number of fused levels (p=0.022) were associated with lower in-hospital transfusion
volumes.

Discussion/Conclusion: ROTEM use during thoracolumbar deformity correction is associated with
lower transfusion requirements. Further investigation will better define the role of ROTEM in
resuscitation during deformity surgery.

148
RF Paper 29

Cost Implications of Primary versus Revision surgery in Adult Spinal Deformity

RABIA QURESHI, BS1, Varun Puvanesarajah, BS2, Amit Jain, MD3, Khaled Kebaish, M.D.4, Adam
Shimer, MD2, Francis Shen, MD5, Hamid Hassanzadeh, MD2
1
, CHARLOTTESVILLE, VA, 2, Charlottesville, VA, 3, Baltimore, MD, 4Johns Hopkins University School
of Medicine, Baltimore, MD, 5, Charlottesville, Virginia

Background/Introduction: Adult spinal deformity (ASD) is an important problem to consider in the
elderly. Though studies have examined the complications of ASD surgery and have compared
functional and radiographic results of primary surgery versus revision, no studies have compared
the costs of primary procedures to revisions. We assessed the in-hospital costs of primary versus
revision surgery in adult spinal deformity patients.

Materials/Methods: The PearlDiver Database, a database of Medicare records, was used in this
study. Mutually exclusive groups of patients undergoing primary or revision surgery were
identified. Patients in each group were queried for age, sex and comorbidities. 30-day readmission
rates, 30-day and 90-day complication rates and postoperative costs of care were assessed with
multivariate analysis. For analyses, significance was set at p < 0.05.

Results: The average reimbursement of the primary surgery cohort was $57,078±30,767.
Reimbursement of revision surgery cohort was $52,999±27,658. The adjusted difference in average
costs between the two groups is $4,178±1214 p< 0.001. The 30 and 90-day adjusted difference in
cost of care when sustaining any of the major medical complications in primary surgery versus
revision surgery was insignificant at $5,522±4,840 p=0.3 and $9,360±5,594 p=0.1 respectively. For
wound infection cost of 30 and 90-day care was insignificant at $7,402±8,624 p=0.4 and significant
at $17,340±8,366 p=0.04 respectively.

Discussion/Conclusion: Patients undergoing primary and revision corrective procedures for ASD
have similar readmission rates, lengths of stays and complication rates. Our data demonstrated a
higher cost of primary surgery compared to revision surgery though costs of sustaining
postoperative complications were similar. This supports the decision to perform revision
procedures in ASD patients when indicated as both outcomes and costs are not a hindrance to
correction.

149
RF Paper 30
A Spine in Limbo: Does the Difference Between Standing and Supine Spino-Pelvic Measurements
of Patients With Adult Spinal Deformity Affect Surgical Decision Making?

Khushdeep Vig, B.A. Biochemistry 1, Awais Hussain, B.A. 2, Robert Merrill, BS3, Jun Kim, MD4, James
Dowdell, MD4, Nathan Lee, BS5, John Di Capua, MHS, BS5, Samantha Jacobs, BA6, Chierika Ukogu,
BA4, Samuel Cho, MD7
1
Mount Sinai Medical Center, Flora, MS, 2, Piscataway, New Jersey, 3Mount Sinai Medical Center,
New York, NY, 4, New York, NY, 5Icahn School of Medicine at Mount Sinai, New York, New York, 6,
New York, New York, 7, NY, NY

Background/Introduction: Adult spinal deformity (ASD) surgery requires meticulous surgical
planning to achieve proper sagittal and coronal alignment, especially if a corrective osteotomy is
required. Supine and standing preoperative radiographs may help to assess spinal flexibility and aid
in surgical decision making.

Materials/Methods: Two independent observers retrospectively recorded spino-pelvic parameters
by measuring standing and supine preoperative radiographs of ASD patients who underwent
posterior spinal fusion (>5 levels fused extending to the sacrum) with corrective osteotomy. All
patients were from a single surgeon at one institution.The difference between standing and supine
spino-pelvic measurements were statistically compared. The patients were divided into cohorts
that received either a 3-column osteotomy (3CO) or a posterior column osteotomy (PCO), and the
change between standing and supine spino-pelvic measurements (∆SPM) was statistically
compared between the two cohorts. Statistical differences were assessed via a Student T-Test with
a p value of < 0.05 set as significant.

Results: 48 patients with sagittal spinal deformity underwent posterior spinal fusion with corrective
osteotomy (23 3CO vs. 25 PCO). The cohort consisted of 31 females and 17 males with an average
age of 62.4 years. For all 48 patients, statistically significant differences were found between
standing and supine positions in the following spino-pelvic measurements: pelvic tilt (mean supine
angle 14.81˚ vs. mean standing angle 23.54˚, p < 0.0001), thoraco-lumbar lordosis (14.13˚ vs.
26.53˚, p < 0.0001), thoracic kyphosis (24.85˚ vs. 32.28˚, p = 0.0018), pelvic incidence lumbar
lordosis mismatch (13.10˚ vs. 22.57˚, p = 0.0057). ∆SPM between osteotomy groups (3CO vs. PSO)
yielded significantly higher ∆lumbar lordosis in the PCO group (21.05 vs. 10.58, p = 0.0384).

Discussion/Conclusion: A statistical difference in certain spino-pelvic measurements was found
between supine and standing pre-operative radiographs of ASD patients undergoing PSF with
corrective osteotomy. Further analysis revealed that patients receiving a PCO displayed a greater
difference in standing vs supine lumbar lordosis compared to 3CO. These results suggest that a
more flexible spinal deformity may require a less invasive corrective osteotomy. These
measurements could be a useful preoperative tool to aid in planning for deformity correction
surgery.
150

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FOUNDED 2008

ELECTRONIC
POSTER ABSTRACTS
152
Poster 01

Trends in Primary and Revision Laminectomy in the United States from 2006 to 2014

Comron Saifi, MD1, Joseph Laratta, MD2, Andrew Pugely, MD2, Alejandro Cazzulino, BA2, Edward
Goldberg, MD3, Ronald Lehman, MD4, Lawrence Lenke, MD2, Howard An, MD5, Frank Phillips, MD3
1
Midwest Orthopedics at Rush, Chicago, IL, 2, New York, NY, 3, Chicago, IL, 4, New York, NY, 5Rush
University Medical Center, Chicago, IL

Background/Introduction: Given the increasing focus on health care utilization and value-based
care, it is essential to determine the number and trends in primary and revision laminectomies per
year throughout the United States. Patient demographics and economic data associated with
primary and revision laminectomy cases is critical to understanding and improving optimal health
care utilization.

Materials/Methods: The data utilized in this study was collected between 2006–2014 across 44
states from the National Inpatient Sample (NIS) database on patients who had undergone primary
laminectomy (ICD-9-CM-03.09) or revision laminectomy (ICD-9-CM-03.02). Demographic and
economic data were obtained which included the annual number of surgeries, age, sex, insurance
type, location, and frequency of routine discharge. The NIS database represents a 20% sample of
discharges from U.S. hospitals, which is weighted to provide national estimates.

Results: An estimated 1,430,987 and 49,998 patients underwent primary and revision laminectomy
procedures, respectively, throughout the U.S. during the study period. The total number of primary
laminectomy operations has progressively decreased slightly from 152,358 to 147,650 over the
nine-year study period. In 2014 Medicare patients comprised 49% of those billed for primary
laminectomy, and 22% of procedures were utilized in areas designated as not low income. Over
72% of primary laminectomies and 69% of revision laminectomies were performed at urban
teaching hospitals. The calculated revision burden for laminectomy surgery over the nine year
study period is 3.4%.

Discussion/Conclusion: Over the past nine years (2006–2014) there has been a slight decrease in
primary and revision laminectomies in the U.S. despite an increase in the elderly U.S. population.
One possibility for the decrease laminectomy procedures is the increasing rate of posterior
interbody fusion procedures, which include a partial decompression in the ICD-9CM billing codes.
Regardless more research is needed to determine the factors causing laminectomy surgery alone to
decrease from 2006 to 2014. The revision burden for laminectomy is only 3.4%, which compares
favorably to other orthopaedic surgeries such as total knee arthroplasty at 8.2% and total hip
arthroplasty at 17.5%.

153

154
Poster 02

90-day reimbursements for primary single level posterior lumbar interbody fusion from
commercial and Medicare data

Nikhil Jain, MD1, Frank Phillips, MD2, Safdar Khan, MD3
1
Ohio State University, Columbus, Ohio, 2, Chicago, IL, 3, Columbus, OH

Background/Introduction: Episode based bundled payments aim to align incentives of all health
care providers towards the common goal of high quality and economic health care. Structuring
such a payment model will require detailed analysis of previous year’s reimbursements, which is
currently not known for a primary single level posterior lumbar interbody fusion. In this context, we
analyze the reimbursement data over the years from Commercial payers and Medicare for this
common spine procedure.

Materials/Methods: Administrative claims data was used to study reimbursements from
Commercial payers (2007–Q3 2015), Medicare Advantage (2007–Q3 2015), and Medicare (2005-
2012) for a primary single level posterior lumbar interbody fusion. Distribution of payments among
various service providers was studied. In addition to descriptive analysis, variation between regions
and payers was studied by a one-way analysis of variance (ANOVA) and post-hoc Tukey test.

Results: Average hospital costs comprise 74.2 to 77 % of the total payments, followed by surgeon’s
fees which accounted for 12.8 to 13.7 %. Post-discharge services comprised 3.6 to 7.1 % of the total
reimbursement. The national 90-day payment amount was $51,465, $26,234 and $25,501 for
Commercial payers, Medicare Advantage and Medicare, respectively. There was some regional
variation, however not consistent among different payers. Inpatient surgery had higher facility
costs than outpatient surgery.

Discussion/Conclusion: Facility costs constitute the majority share in a 90-day bundle amount.
Surgery done in the outpatient setting is associated with lower facility costs than inpatient surgery.
Overall burden of readmissions/revisions was 2.1 to 2.7%, but for the readmitted patient they
constitute 25 to 54 % of the 90-day payment.

155
Poster 03

Development of Common Language Descriptions Correlating with PROMIS

Jason Ferrel, MD1, Chong Zhang, M.S.1, Angela Presson, PhD2; Rasheed Abiola, MD1, Nicholas Spina,
MD1, W. Ryan Spiker, MD2, Brandon Lawrence, MD2, Darrel Brodke, MD2
1
University of Utah, Salt Lake City, Utah, 2, Salt Lake City, Utah

Background/Introduction: The Patient Reported Outcome Measurement Information System
(PROMIS) is a system of instruments that implements item response theory (IRT) and computerized
adaptive testing (CAT) designing it to be precise, reliable, and versatile. PROMIS has been validated
in the lumbar spine patient population and has been found to be more useful than other popular
patient reported outcome measures. However, currently the use of PROMIS is limited in part
because many clinicians lack a common language understanding of the meaning and the
significance of PROMIS scores. The objective of this study was to develop rational plain language
descriptions to apply to PROMIS Physical Function scores.

Materials/Methods: We retrospectively analyzed prospectively collected PROMIS Bank v1.2
Physical Function (PROMIS-PF) scores compiled in a database. Patients presenting for office visits
(encounters) related to their back and/or lower extremity were included. Patients with missing
scores, standard error >0.32, missing injury location, and assessments with <4 questions or more
than 12 questions were excluded. PROMIS-PF scores from each encounter were grouped by scores
to allow practical and rational application of common language descriptions based on the questions
and answers for the scoring groups.

Results: In total, 12,712 encounters and 5,524 patients were included in the analysis. The mean
PROMIS-PF score for all encounters was 37.2 (standard deviation 8.2). 90% of encounters were
completed in 4 questions to generate the PROMIS-PF score. The frequency of question and answer
occurrences was analyzed. The set of rationale was applied and used to develop common language
descriptions of each PROMIS PF score group (Table 1). For example, a score of 35 ± 2 means
someone is able to do chores such as vacuuming or yard work with much difficulty, can carry a
laundry basket up a flight of stairs with much difficulty, can walk at normal speeds with some
difficulty, and can run errands and shop with some difficulty.

Discussion/Conclusion: This study developed rational plain language descriptions to enhance the
understanding and application of PROMIS Physical Function scores for patients presenting with
back and lower extremity complaints in the clinical and research settings.

156

157
Poster 04

PROMIS Physical Function Outcomes in Diabetic Patients Undergoing Lumbar Spine Surgery

Mathieu Squires, B.S.1, Ashley Neese, B.S.2, Yue Zhang, PhD3, Brandon Lawrence, MD2, W. Ryan
Spiker, MD2, Darrel Brodke, MD2
1
University of Utah School of Medicine, Salt Lake City, UT, 2, Salt Lake City, Utah, 3University of
Utah, Salt lake City, Utah

Background/Introduction: PROMIS Physical Function (PF) Computer Adaptive Testing (CAT) is an
NIH-funded, subjective measure of patient physical function, and has been validated in the spine
population. Little is known about the effects of comorbidities on the outcomes of surgery as
assessed by the PROMIS PF CAT. The purpose of this study was to compare the physical function
outcomes of diabetic patients and nondiabetic patients before and after lumbar spine surgery, as
assessed by PF CAT.

Materials/Methods: PF CAT questionnaires were administered on electronic tablets to spine
patients from October 1, 2013 to December 31, 2015 at a single university-based spine clinic.
Patients were included if they had completed PF CAT questionnaires, were greater than 18 years of
age, and had undergone any lumbar spine surgery within the aforementioned dates. Diabetic
status of each patient was determined, and PF CAT scores were collected for the 3 months
preoperative, and at 3, 6, and 12 month postoperative time points. Wilcox and Exact Wilcox tests
were used to analyze median PF CAT scores and median age-adjusted PF CAT percentile ranks.

Results: Of 299 patients identified, 85 were diabetic (mean age 65, 58% male) and 214 were
nondiabetic (mean age 55, 57% male). Median PF CAT scores were significantly different between
diabetic and nondiabetic cohorts at the 3 months preoperative and 6 months postoperative time
points. At 3 months preoperative, diabetic and nondiabetic scores were 31.4 and 34, respectively
(p=0.011). At 6 months postoperative, diabetic and nondiabetic scores were 39.5 and 42.0,
respectively (p=0.015). When looking at median age-adjusted PF CAT percentile ranks, rather than
raw scores, no significant difference in percentile ranks between diabetics and nondiabetics was
found at any of these time points (Figure 1).

Discussion/Conclusion: Patients with Diabetes Mellitus had significantly lower PROMIS Physical
Function scores 3 months before and 6 months after lumbar surgery when compared with
nondiabetic patients. However, when scores were adjusted for age this difference disappeared,
highlighting the importance of this demographic when evaluating PROMIS Physical Function scores.

158

159
Poster 05

Radiographic and Clinical Outcomes of Anterior and Transforaminal Lumbar Interbody Fusions: A
Systematic Review and Meta-Analysis of Comparative Studies

Remi Ajiboye, MD1, Haddy Alas, BA2, Akshay Sharma, BA3, Sina Pourtaheri, MD4
1
UCLA Medical Center, Los Angeles, CA, 2SUNY Downstate College of Medicine, Brooklyn, NY,
3
Case Western Reserve University, School of Medicine, Cleveland Heights, OH, 4University of
California, Los Angeles, Santa Monica, California

Background/Introduction: ALIF and TLIF with pedicle screw fixation are two methods of achieving
spinal arthrodesis. There are conflicting reports with no consensus on the optimal interbody
technique to achieve successful radiographic and clinical outcomes. Given these findings, a
systematic review and meta-analysis of the current literature was performed in order to better
compare radiographic and clinical outcomes of ALIF and TLIF

Materials/Methods: A systematic search of multiple medical reference databases was conducted
for studies comparing ALIF to TLIF. Studies that included stand-alone ALIFs were excluded. Meta-
analysis was performed using the random-effects model for heterogeneity. Radiographic outcome
measures included segmental and overall lumbar lordosis, and fusion rates. Clinical outcomes
measures included Oswestry disability index (ODI) and visual analog scale (VAS) score for back pain.

Results: The search yielded 7 studies totaling 811 patients (ALIF = 448, TLIF = 363). ALIF was
superior to TLIF in restoring segmental lumbar lordosis at L4-5 and L5-S1 ((L4-5; SMD = 4.655, 95%
CI: 2.76 - 8.31, p = 0.013), (L5-S1; SMD = 3.728, 95% CI: 1.710 - 5.746, p < 0.001)). ALIF was also
superior to TLIF in restoring overall (T12 or L1-S1) lumbar lordosis (SMD = 4.022, 95% CI: 2.71 -
5.333, p < 0.001). However, no significant differences in fusion rates were noted between both
techniques (OR = 0.905, 95% CI: 0.458 - 1.789, p = 0.775). Additionally, ALIF and TLIF were
comparable with regards to ODI and VAS scores ((ODI; SMD = 1.782, 95% CI: -0.849 - 4.413, p =
0.184), (VAS; SMD = 0.00784, 95% CI: -0.732 - 0.748, p = 0.983)).

Discussion/Conclusion: In patients with sagittal imbalance whereby restoration of lumbar lordosis
is paramount, ALIF is superior to TLIF. However, for patients with degenerative spinal pathologies
without significant deformity, TLIF is comparable to ALIF with regards to fusion rate and clinical
outcomes.

160
Poster 06

Open fixation and fusion versus percutaneous pedicle screw fixation for treatment of
thoracolumbar flexion distraction injuries

Assem Sultan, MD1, Joseph Drain, MD2, Jonathan Belding, MD3, Michael Kelly, MD3, James Liu, MD4,
Michael Steinmetz, MD5, Timothy Moore, MD6
1
Cleveland Clinic, Cleveland, OH, 2, Cleveland, OH, 3Metrohealth Medical Center, Cleveland, OH,
4
Metrohealth medical center, Cleveland, OH, 5Cleveland Clinic, Department of Neurosurgery ,
Cleveland, OH, 6Metrohealth Medical Center , Cleveland , OH

Background/Introduction: Flexion distraction injuries of the thoracolumbar spine describes a
subset of fractures with posterior ligamentous complex disruption in response to a flexion and
distraction moment imparted to the thoracolumbar spine. These injuries are mechanically and
neurologically unstable and surgical stabilization is frequently necessary to prevent neurological
deterioration and maintain sagittal alignment. Conventionally, open posterior fixation and fusion
have been utilized as the standard surgical treatment. Recently, percutaneous techniques with
pedicle screws insertion are becoming popular as they provide stabilization without the morbidity
associated with the open approach. To date, our study remains the largest study directly comparing
the two methods.

Materials/Methods: Patients with flexion distraction injuries who were treated surgically between
July 2005 and August 2015 at our institute were prospectively followed. Patients were treated with
either open posterior pedicle screw fixation and fusion or posterior percutaneous pedicle screw
fixation. For all patients, the American Spinal Injury Association scores and radiographic sagittal
plan parameters were recorded preoperatively, postoperatively and on subsequent follow ups. We
compared the two treatment groups regarding intraoperative blood loss, operating room time,
length of hospital stay and complications.

Results: 70 patients who underwent surgical stabilization for thoracolumbar flexion distraction
injuries were identified. Open posterior pedicle screw fixation with posterolateral fusion was
performed in 52 patients while 18 patients underwent percutaneous pedicle screw fixation. Neither
groups showed a statistically significant difference in terms of American Spinal Injury Association
scores or sagittal alignment. The percutaneous pedicle screw fixation group showed less blood loss
and shorter operative time.

Discussion/Conclusion: Flexion distraction injuries of the thoracolumbar spine usually necessitate
operative treatment. Percutaneous pedicle screw fixation allows for adequate stabilization with
less intraoperative blood loss and avoids the morbidity associated with conventional open
approach.

161
Poster 07

Hospital Ownership and Teaching Status Affects Perioperative Outcomes Following Lumbar
Spinal Fusion

Wesley Durand, ScB1, Joseph Johnson, ScB (2018)2, Neill Li, BS, MD3, JaeWon Yang, BA1, Adam
Eltorai, BA4, J. Mason DePasse, MD5, Alan Daniels, MD6
1
Brown University, Warren Alpert Medical School, Providence, RI, 2Brown University, Providence,
RI, 3Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence,
RI, 4Warren Alpert Medical School of Brown University, Providence, RI, 5Department of
Orthopaedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island,
6
Department of Orthopaedics, Division of Spine Surgery- Adult Spinal Deformity Service, Warren
Alpert Medical School of Brown University, Providence, Rhode Island

Background/Introduction: Hospital ownership and teaching status may influence care quality. This
study investigated how hospital ownership and teaching status affects perioperative outcomes
following lumbar spinal fusion.

Materials/Methods: This investigation analyzed lumbar spinal fusion discharges in the Nationwide
Inpatient Sample from 2002-2012. Hospital ownership was determined utilizing the AHA Survey of
Hospitals. Teaching status was derived from the presence of AMA-approved residency program,
Council of Teaching Hospitals membership, or a trainee/bed ratio of >0.25. In covariate-adjusted
analyses, multivariate regression was used to account for confounding variables, including: patient
age, gender, primary payer, severity score, primary vs. revision fusion, national region, hospital bed
size, and year. Statistical significance was set at p<0.05, a priori.

Results: In total, 453,761 lumbar spinal fusion discharges were analyzed. Compared to patients
from for-profit hospitals, patients from non-profit hospitals exhibited increased odds of inpatient
mortality (OR=1.55, p=0.0009), total complication rate (OR=1.14, p=0.0020), length of stay (LOS)
(ratio=1.14, p<0.0001), and decreased total charges (ratio=0.75, p<0.0001). Discharges from urban
non-teaching hospitals were associated with decreased odds of mortality (OR=0.73, p=0.0003),
fewer total complications (OR=0.88, p=0.0003), and decreased LOS (ratio=0.88, p<0.0001)
compared to discharges at urban teaching hospitals. Covariate-adjusted analysis revealed a
significant association between discharge from non-profit hospitals and decreased total charges
(ratio=0.76, p<0.0001) and increased LOS (ratio=1.04, p=0.0249) compared to discharge from for-
profit hospitals. After covariate-adjusted analysis, patients discharged from urban non-teaching
hospitals exhibited decreased odds of complications (OR=0.93, p=0.0306) and decreased LOS
(ratio=0.90, p<0.0001) compared to patients discharged from urban teaching hospitals.

Discussion/Conclusion: Hospital ownership and teaching status may affect perioperative outcomes
following lumbar spinal fusion, although these findings may largely reflect differing patient
populations. After adjusting for patient severity and demographics, non-profit hospitals were found
to have significantly lower charges and longer LOS compared to for-profit hospitals, and teaching
hospitals had higher complication rates and longer LOS compared to non-teaching hospitals.
162
Further examination of the mechanisms affecting complication rate, LOS, and charges based on
hospital ownership and teaching status is warranted.

163
Poster 08

In Hospital Narcotic Usage Is Significantly Lower for Minimally Invasive Spine Surgery Versus
Open Spine Surgery

David Falk, MD Student1, Michael Hoy, MD Student1, Darshan Vora, MD Student1, Natalie Studdard,
NP2, Warren Yu, MD1; Joseph O’Brien, MD, MPH3
1
George Washington University Department of Orthopaedic Surgery, Washington, DC, 2The
Orthopaedic Center, Rockville, MD- MARYLAND, 3, Rockville, MD

Background/Introduction: Minimally invasive surgery has been shown to be cost effective, have a
shorter length of stay and decreased need for perioperative blood transfusion. Recent public
awareness has focused on narcotic usage as detrimental to the public health. The focus of the
present study was to examine length of stay and perioperative narcotic usage for open versus
minimally invasive spinal surgery

Materials/Methods: Institutional board approval was obtained for a retrospective review of
patient data from 2014 to 2015 A retrospective analysis was performed for 40 patients that
underwent minimally invasive spine surgery versus 70 that had open surgery. Data were collected
on inpatient narcotic usage and length of stay. Opioid use was standardized by using equi-analgesia
chart and total dose was calculated. Average total dose was compared using statistical analysis and
p values were calculated

Results: Average narcotic usage for minimally invasive versus open lumbar spinal surgery was
statically significantly lower. Average equi-analgesic dose post operatively was 278 mg v. 423 mg (p
0.03). Intraoperative use showed a trend towards lower usage but was not statistically significant
(26 mg v. 32 mg, p = 0.07). Average length of stay approached 1 day shorter for all minimally
invasive cases versus open cases (p = 0.18).

Discussion/Conclusion: Open spinal surgery versus minimally invasive spine surgery requires
approximately 2 times the amount of narcotics for management of post operative pain control.
Intraoperative narcotic usage was not significantly different and length of stay approached one day
shorter for minimally invasive cases.

164

165
Poster 09

Efficacy of Anti-fibrinolytics and When They Reduce Blood Loss During Spinal Deformity Surgery

Swamy Kurra, MBBS1, Benjamin Meath, BS2, Akshay Yadhati, MD2, Richard Tallarico, MD1; Mike
Sun, MD1, William Lavelle, MD1
1
, Syracuse, NY, 2SUNY Upstate Medical University, Syracuse, NY

Background/Introduction: Adult spinal deformity correction surgery often involves significant
intraoperative blood loss with numerous complications. Surgeons have begun administering peri-
operative anti-fibrinolytic agents which significantly reduces intraoperative blood loss. The purpose
was to determine which phase of surgery anti-fibrinolytics (antifib) will decrease blood loss
compared to blood loss incurred without anti-fibrinolytic administration in adult thoracolumbar
deformity surgeries.

Materials/Methods: Reviewed consecutive surgical case logs (2012-2015) from two spinal
deformity surgeons. Inclusion criteria: age > 18 years, thoracolumbar surgeries, surgery duration
between 6 and 9 hours, and levels of fusion > 7. Patients divided into two groups: 43 patients with
no osteotomies (Group 1) and 22 patients with osteotomies (Group 2). We compared blood loss for
every 2 hours in Groups 1 and 2 between patients receiving anti-fibrinolytic agents and no anti-
fibrinolytics. ANOVA and Chi square analyses performed; p < 0.05 was considered statistical
significant.

Results: Study consisted of 65 patients: mean age of 60±16 years. The number of levels fused and
duration of surgery with and without antifib patients were not statistically significant in both
Groups 1 and 2. In Group 1 (Table 1 and Graph 1): TBL was 1.8L & 2.2L (p=0.18) in patients without
and with anti-fibrinolytics, respectively; blood loss in patients (no Fib vs with Fib) at first 2 hours
(490 vs 620ml), between third and fourth hour (550 vs 682ml), fifth and sixth hours (512 vs 641ml),
and seventh and eighth hour (500 vs 471ml). In Group 2: TBL was 1.5L and 2L (p=0.17) in in patients
without and with anti-fibrinolytics, respectively; blood loss in patients (no Fib vs with Fib) at first 2
hours (422 vs 550ml), between third and fourth hour (409 vs 716ml), fifth and sixth hour (407 vs
450ml), and seventh and eighth hour(264 vs 412ml). The TBL and blood loss at every 2hours are not
statistically significant between patients in Group 1 and 2.

Discussion/Conclusion: Antifibrinolytics started decreasing blood loss after 4 hours from the start
of surgery. Antifibrinolytics patients had more TBL and blood loss at every time internal. Our low
sample size failed to show any statistical significance between with and without antifibrinolytic
patients.

166

167
Poster 10

The Use of Liberal Transfusion Triggers: Outcomes after Spine Surgery

Taylor Purvis, BS1, Rafael De la Garza-Ramos, M.D.2, C. Rory Goodwin, M.D./Ph.D.2, Steven Frank,
MD3; Timothy Witham, MD4, Daniel Sciubba, M.D.2
1
Johns Hopkins School of Medicine, Baltimore, MD, 2Johns Hopkins Hospital, Baltimore,
Maryland, 3, Baltimore, MD, 4Johns Hopkins University School of Medicine, Baltimore, MD

Background/Introduction: While blood transfusions are commonly used in spine surgery, they are
associated with increased intra- and postoperative patient morbidity. No studies have examined
the association between the reliance on liberal hemoglobin triggers—that is, an intraoperative
hemoglobin level of ≥10 g/dL or a postoperative level of ≥8 g/dL—and perioperative morbidity in
spine surgery patients. In this study, we examined the association between perioperative outcomes
and a liberal transfusion strategy during spine surgery.

Materials/Methods: Institutional inpatient surgical records were queried for spine surgeries
between 2008 and 2015. Included in this group were patients undergoing spinal fusion, tumor-
related surgeries, and other spine surgeries. Variables analyzed included mortality, in-hospital
morbidity, and length of stay associated with liberal transfusion triggers.

Results: A total of 6931 patients undergoing spine surgery were identified and separated into eight
major procedural groups. For patients with an entire hospital stay hemoglobin nadir between 8 to
10 g/dL, transfused patients had longer in-hospital stays (median [IQR], 6 [5-9] vs. 4 [3-6] days;
P<0.0001) and higher perioperative morbidity (n=145, [11.5%] vs. n=74, [6.1%]; P<0.0001) than
those not transfused. Moreover, even after adjusting for potential confounders such as age,
estimated blood loss, number of operated levels, ASA class, CCI score, and surgery type, patients
with a hemoglobin nadir of 8-10 g/dL who were transfused had an independently higher risk of
perioperative morbidity (odds ratio [OR] = 2.12; 95% confidence interval [CI], 1.24-3.64; P=0.006).

Discussion/Conclusion: Reliance on liberal transfusion triggers is associated with worse
perioperative outcomes, even after adjusting for confounders. Clinicians may wish to consider
alternative transfusion triggers for spine surgery patients to reduce patient morbidity.

168
Poster 11

Cigarette Smoke-Induced Inhibition of Osteogenesis Through Involvement of the Aryl
Hydrocarbon Receptor

Chawon Yun, PhD1; Andrew Schneider, MD2, Karina Katchko, BS2, Gurmit Singh, BS2, Jonghwa Yun,
N/A2, Andrew George, BS2, Nehal Samra, N/A2, Sohyun Lee, N/A2, Wellington Hsu, M.D.3, Erin Hsu,
PhD4
1
Northwestern University Department of Orthopaedic Surgery , Chicago, IL, 2, Chicago, IL,
3
Northwestern Memorial Hospital, Chicago, Illinois, 4Northwestern University Department of
Orthopaedic Surgery, Chicago , IL

Background/Introduction: Cigarette smoking significantly impairs bone regeneration and is
associated with higher rates of pseudarthrosis after spine fusion procedures. However, the
molecular mechanisms underlying these effects are unclear. Recent work has implicated the Ahr in
mediating the inhibition of osteogenic differentiation by several ligands found in cigarette smoke.
Our previous work with dioxin, a constituent of cigarette smoke and high-affinity ligand of the Ahr,
has shown that dioxin exposure inhibits bone regeneration and spine fusion in vivo. The purpose of
this study was to elucidate the mechanisms underlying the adverse effects of Cigarette Smoke
Extract (CSE) —the Ahr ligand-containing fraction of cigarette smoke—on bone regeneration.

Materials/Methods: Bone marrow stromal cells (BMSC) were harvested from Long-Evans rats and
cultured under standard or osteogenic conditions. CSE was prepared by drawing smoke from
reference cigarettes through a 0.1 μm PTFE filter and washing the filter in DMSO to yield a
concentration of 40 mg/mL. Factors critical to osteogenesis were then evaluated after BMSC were
exposed to DMSO vehicle, 10 or 20 ug/mL CSE, or co-treated with Ahr antagonists (4 μM
Resveratrol, Res; 2 μM α-Naphthoflavone, ANF; 10 μM 3’3-Diindolylmethane, DIM). Endpoints
included cell viability (MTS assay), ALP activity, mineralization, and gene and protein expression of
targets relevant to osteogenic differentiation.

Results: CYP1A1 mRNA was induced in CSE-treated BMSC, as was ethoxyresorufin-o-deethylase
(EROD) activity, both of which are markers for Ahr activation. CSE reduced cell number and ALP
activity, and also inhibited mineral deposition relative to vehicle control. Expression of ALP, OCN,
RUNX2, CXCL12, PHEX, and OPN were also reduced. Co-treatment with each of the Ahr antagonists
generally mitigated these effects.

Discussion/Conclusion: Our results suggest that Ahr activation may play a critical role in the
adverse effects of cigarette smoke on bone healing, and that these effects may be reduced with
Ahr antagonist co-treatment. Administration of natural and synthetic Ahr antagonists should be
investigated as a therapeutic option to block these inhibitory effects.

169

170
Poster 12

Minimally invasive retroperitoneal anterolateral psoas-sparing (ATP) lumbosacral fusion: Is it
safe?

Chadi Tannoury, MD1, Tony Tannoury, MD2; Brian Mercer, MD3
1
Boston University Medical Center, Boston, MA, 2Boston University Medical Center, Boston,
Massachusetts, 3, Boston, MA

Background/Introduction: Lumbar fusion using the transpsoas technique is notorious for
catastrophic neurovascular and visceral injuries. Therefore, psoas-sparing anterolateral technique
has been gaining attention. However, the safety profile of this novice technique is not well
investigated, particularly at the level of L5-S1. A minimally invasive anterolateral retroperitoneal
psoas-sparing approach (anterior to the psoas: ATP) of the lumbosacral spine (T12-S1) has been
adopted and finessed by the senior authors over the past 10 years.

Materials/Methods: Patients with degenerative lumbar disorders requiring a minimally invasive
ATP lumbar fusion (between T12-S1) at our institution, between 2007 and 2011, were identified
(396 subjects). (Figure 1) A retrospective chart review of the postoperative morbidity and mortality
database was conducted and analyzed. (Table 1) A muscle splitting retroperitoneal ATP approach,
including the L5-S1 segment, was performed in all identified patients.

Results: Overall, twelve patients (3%) were noted to develop postoperative complications.
Surprisingly, the majority of the surgical complications (7 out of 12: 58%) were related to the
posterior fusion rather than the anterior approach (2 out of 12: 16%). Neurologic deficits were only
encountered in 2 patients, with complete resolution at final follow-up (2 years). There were no
vascular or visceral injuries encountered with the ATP technique, however the noted complications
in this series were technical in nature (Cage displacement due to adjacent vertebral body fracture,
and anterior neural contusion with neurapraxia), did not involve the L5-S1 segment, and required
revision surgeries.

Discussion/Conclusion: Minimally invasive ATP lumbosacral fusion, although technically
demanding, is safe and feasible in patients with degenerative spinal disorders. Beside sparing the
psoas muscle compartment and its contents, this technique allows for direct visualization, and
therefore protection, of the peri-spinal neurovasculature and abdominal visceral structures
between T12-S1. Direct and indirect neural decompression, as well as controlled anterior column
release can be performed through a single muscle splitting approach between T12-S1. Despite a
steep learning curve, the safety profile of this technique is favorable and promising.

171

172

173
Poster 13

Effect of Local Delivery of SDF-1 and Postoperative Stem Cell Mobilization on Bone Formation
and Interbody Fusion in an Ovine Model

Jonathon Geisinger, M.D.1, Richard Roberts, M.D.1, Chad Jones, M.D.1, Abby Davidson, M.S.2,
Meagan Salisbury, M.S.1, Tristan Maerz, Ph.D.3, Daniel Park, MD4, Jeffrey Fischgrund, MD3; Kevin
Baker, Ph.D3
1
Beaumont Health, Royal Oak, MI, 2William Beaumont Hospital, Royal Oak, MI, 3, Royal Oak,
Michigan, 4, Royal Oak, MI

Background/Introduction: Mesenchymal stem cell-based therapies represent an attractive
approach for augmenting bone formation in spine fusion. MSC-based techniques have failed to gain
widespread clinical adoption primarily due to time-, and labor-intensive ex vivo processing steps.
We hypothesize that these steps can be eliminated by directing the recruitment of endogenous
MSC populations. To this end, we evaluated the effect of local delivery of a chemotactic factor
(SDF-1b) and post-operative administration of a stem cell mobilizing agent (AMD3100) on bone
formation in an ovine model of interbody fusion.

Materials/Methods: Under an IACUC approved protocol, 20 Dorsett-Cross ewes underwent single-
level ACDF. A PEEK cage filled with 1.0 cc of a commercially-available collagen/b-TCP/bioglass graft
material and loaded with either SDF-1b (100 ng) or saline, was implanted at C4-C5. Following
surgery, sheep were randomized to undergo a single subcutaneous injection of a stem cell
mobilizing agent (AMD3100, 240 ug/kg) or saline. Four treatment groups were evaluated
(n=5/group): Control, SDF-1b only, AMD3100 only, and SDF-1b+AMD3100. Blinded observers
graded fusion status based on bone formation within the interbody cage observed on clinical CT,
nondecalcified histology and backscattered electron imaging at the 16 week endpoint using a four-
point ordinal scale adopted from Kandziora, et al.

Results: Clinical CT demonstrated at 60% fusion rate in the SDF-1b only group, 40% fusion in the
AMD3100 and SDF-1+AMD3100 groups, and 0% solid fusion in the Control group at 16 weeks. Both
nondecalcified histology and backscattered electron imaging showed a 100% fusion rate in the
AMD3100 only group, while 60% of the SDF-1b only animals were fused, and 40% of animals in
both the SDF-1b+AMD3100 and Control group showed solid fusion. Quantitative histologic analyses
showed that the AMD3100 only group had the greatest mean area fraction of mineralized tissue
within the interbody cage.

Discussion/Conclusion: This study demonstrated that local delivery of a chemotactic factor (SDF-
1b) and post-operative administration of a stem cell mobilizing agent (AMD3100) separately
enhance bone formation. Quantitative analysis of nondecalcified histologic sections demonstrated
that a single post-operative injection AMD3100 increased the mean area fraction of bone within
the cage and promoted solid fusion in 100% of animals.

174

175
Poster 14

Preoperative Obesity Class III Designation as a Risk Factor for Major Postoperative Complications
after Anterior Lumbar Fusion

Chierika Ukogu, BA1, Samantha Jacobs, BA2, William Ranson, BS1, Sulaiman Somani, BS3, Jun Kim,
MD1, John Di Capua, MHS, BS3, Awais Hussain, B.A. 4, Samuel Cho, MD5
1
, New York, NY, 2, New York, New York, 3Icahn School of Medicine at Mount Sinai, New York,
New York, 4, Piscataway, New Jersey, 5, NY, NY

Background/Introduction: Introduction: Approach related complications have been well studied in
adults undergoing anterior lumbar fusion (ALF). However, no study has been able to quantify risk of
postoperative complications in patients with obesity class III (BMI>40) designation prior to surgery.
It is important to understand which risk factors are independently associated with morbid obesity
in order to treat these patients accordingly.

Materials/Methods: Methods: This was a retrospective analysis of the American College of
Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database between 2011 and
2014 for patients undergoing ASD surgery. Patients were included based on Current Procedural
Terminology (CPT) codes. Patients with age <18 years, non-elective surgery, emergency surgery,
within 30 days of the principal operation were excluded from the study. Patients with a BMI equal
to or over 40 were categorized into obesity Class 3 (OC3) and those with lower BMI were labeled as
non-obesity Class 3 (NOC3). Multivariate logistic regression was utilized to uncover any associations
between obesity classification and adverse outcomes.

Results: Results: 3,152 cases met the inclusion criteria for this study, and 190 (6.02%) of them were
classified in OC3. Obesity classification was found to be an independent risk factor for mortality
(OR=7.19, 1.42-44.17, p-value=0.018), wound complications (OR=3.01, 1.53-5.97, p-value=0.0015)
sepsis (OR=3.76., 1.25-11.25, p-value=0.018), and unplanned readmission (OR=2.3, 1.4-4.0, p-
value=0.0038) through multivariate logistic regression revealed comparing OC3 vs. NOC3.

Discussion/Conclusion: Conclusion: Patients with BMI over 40 had an obesity class III designation.
This classification is significantly and independently associated with and increased risk of morality,
wound complications, sepsis, and unplanned readmission for patients undergoing ALF. Given the
gravity of these postoperative complications, surgeons should counsel patients appropriately.

176

177
Poster 15

The Utility of In-hospital Postoperative Radiographs Following Surgical Treatment of Traumatic
Thoracolumbar Injuries

Joseph Pyun, MD 1, Tristan Weir, BS2, Daniel Gelb, MD2; Steven Ludwig, MD2, Eugene Koh, MD,
PhD2, Kelley Banagan, MD2, Luke Brown, MD2
1
University of Maryland Medical Center, Baltimore, Maryland, 2, Baltimore, MD

Background/Introduction: Previous studies have concluded that postoperative radiographs
following lumbar fusion for degenerative conditions have limited clinical value, especially in the
absence of changes in symptoms or examination. In order to obtain these radiographs, patients are
subject to radiation and inconvenience at a cost to the healthcare system. Our hypothesis is that
routine in-hospital postoperative radiographs following surgical treatment of traumatic
thoracolumbar (TL) injuries are unnecessary in the absence of changes in symptoms or
examination.

Materials/Methods: A retrospective review of patients who underwent surgical treatment of
traumatic TL injuries between December 2006 and October 2015 at a Level I trauma center by four
fellowship-trained spine surgeons was performed. Prior to discharge, postoperative upright AP and
lateral radiographs were obtained and reviewed by one of the surgeons as per standard protocol.
Those patients who subsequently underwent revision surgery were identified and further analyzed
to identify demographic information, injury pattern, mechanism of injury, index and revision
procedures, and reason for intervention.

Results: 500 patients (353 males and 147 females) were identified with a mean age of 44.6 years
(range, 18-90. Only one patient, a 18 year-old male who sustained a L2 burst fracture, had revision
surgery secondary to abnormal routine postoperative radiographs. Six other patients (five males
and one female) with a mean age of 35.8 years (range, 18-75) underwent revision surgery due to
worsening or continuing neurologic deficits or findings from advanced imaging. The injury patterns
included 4 burst fractures and 3 flexion-distraction injuries. The index procedures included 5
percutaneous posterior stabilizations and 2 open posterior decompressions and instrumented
fusions.

Discussion/Conclusion: Routine in-hospital postoperative radiographs following surgical treatment
of TL injuries are of little value, especially in the absence of changes in examination or symptoms.
The rate of revision surgery during the initial hospitalization was 1.4% (7/500) in our study. Only
0.2% (1/500) returned to the operating room for revision of instrumentation as a result of an
abnormality found on routine postoperative radiographs. With today’s increasing emphasis on cost
efficiency and evidence based practice, this study may contribute to a movement to discontinue
routine postoperative radiographs following spine surgery.

178

179
Poster 16

How Does Case Type, Length of Stay, and Comorbidities Affect Medicare DRG Reimbursement for
Minimally Invasive Surgery (MIS) for Deformity?

Pierce Nunley, MD1, Richard Fessler, MD, PhD2, Gregory Mundis, M.D., 3, Robert Eastlack, M.D., 4,
Dean Chou, MD5, Christopher Shaffrey, MD6, Praveen Mummaneni, MD7, International Spine Study
Group (ISSG), -8
1
Spine Institute of Louisiana, Shreveport, Louisiana, 2Rush University Medical Center, Chicago, IL,
3
San Diego Spine Foundation , San Diego , California, 4Scripps Clinic, La Jolla , California ,
5
University of California, San Francisco, San Francisco, California, 6University of Virginia Medical
Center, Charlottesville, VA, 7, San Francisco, California, 8, Littleton, Colorado

Background/Introduction: We investigated Medicare DRG based reimbursement for MIS deformity
procedures in our study group hospitals based on length of stay and presence of comorbid
conditions (CC).

Materials/Methods: DRG based reimbursement was obtained for MIS anterior, posterior and
circumferential 1-level and multi-level fusion for listhesis and deformity cases with and without CC
from 12 institutions throughout the US. The 3 most common MIS procedures were analyzed to
compare reimbursement based on DRG coding: 1. Fusion via anterior or posterior only; 2. Fusion
anterior with fixation posterior percutaneous (no dorsal fusion); 3. Fusion Combined anterior and
posterior.

Results: The number of levels fused does not affect the reimbursement for all cases. Cases 1 and 2
without CC, 3-day stay reimbursed $41,404 vs 8-day reimbursed $42,808. Cases 1 and 2 with CCs,
3-day stay reimbursed $54,476 vs 8-day stay reimbursed $55,881. Case 3 without CC, 3-day stay
reimbursed $47,992 vs 8-day stay reimbursed $49,397. Case 3 with CC, 3-day reimbursed $61,806
vs 8-day reimbursed $63,212. The increased payment for an 8-day stay was $1,405 or $281 per day.
If a deformity case 1 or 2 is coded incorrectly as a degenerative case the decrease in payment was
$9,769 lower (-24%) with no CC and $22,841 lower (-42%) with CC.

Discussion/Conclusion: Regardless the direct costs, Medicare DRG based reimbursement was the
same for single and multi-level MIS deformity cases. The use of posterior percutaneous fixation
without dorsal fusion resulted in a 13-16% lower reimbursement compared with the addition of a
posterior arthrodesis. Coding a deformity case as degenerative by the hospital resulted in 24-42%
lower DRG based reimbursement. In today’s challenging environment it is important that
physicians and hospitals better understand procedure and coding issues in order to be able to
continue to offer complex spinal surgeries cost effectively to our patients.

180

181
Poster 17

Do Former Smokers Exhibit a Distinct Profile Before and After Lumbar Spine Surgery?

Ehsan Jazini, MD1, Leah Carreon, MD2, Steven Glassman, MD3
1
, Baltimore, MD, 2, Louisville, Kentucky, 3, Louisville , Kentucky

Background/Introduction: While smoking has been found to have myriad of deleterious effects on
patients undergoing lumbar spine surgery, there has been little data evaluating those who have
quit, i.e. former smokers. There are also no studies evaluating a dose-response relationship
between number of pack years and duration of smoking cessation prior to lumbar surgery on
patient reported outcomes(PROs). We hypothesized that former smokers undergoing lumbar spine
surgery have distinct baseline and post-operative PROs.

Materials/Methods: The prospective N2QOD database and electronic medical records were
evaluated for smoking history and PROs: back and leg pain, Oswestry Disability Index and EuroQOL-
5D scores, pre-operatively and at 3 and 12 months post-operatively in 483 patients who had
lumbar spine surgery. Three cohorts, Never smokers, Former smokers and Current smokers were
evaluated. Associations between pack years and duration of smoking cessation preoperatively with
PROs were also assessed.

Results: 455 (94%) cases had complete smoking history with 12-month follow up. There were 209
Never, 171 Former, and 75 Current smokers. The distribution of diagnostic indication, workers’
compensation, ASA grade and surgery type were similar among the cohorts. Baseline, 12 month,
and improvement in PROs were significantly different with Current smokers having the worst
scores, followed by Former smokers and Never smokers (Table 1). In Former smokers there was no
significant correlation between pack years of smoking with baseline, 12 month, or change in PROs.
Although there were significant negative correlations between the number of smoke- free days
prior to surgery with baseline back and ODI,12-month leg and ODI scores and improvement in ODI
scores, the coefficients were small, indicating a low degree of correlation.

Discussion/Conclusion: Former smoking has detrimental effects on baseline health outcomes and
the degree of their improvement.

182

183
Poster 18

Can Liposomal Bupivacaine Be Safely Utilized in Patients Undergoing Spine Surgery?

Luke Brown, MD1; Mark Shasti, MD2, Julio Juaregui, MD2, Steven Ludwig, MD1, Daniel Gelb, MD1,
Eugene Koh, MD, PhD1, Kelley Banagan, MD1
1
, Baltimore, MD, 2University of Maryland Medical Center, Baltimore, Maryland

Background/Introduction: Currently, there are many strategies utilized to control the pain level;
however, most of these strategies are based on narcotics. Among these different strategies the
multimodal use of liposomal bupivacaine (LB) has provided successful pain relief, the safety has
never been evaluated in patients undergoing spine surgery. We attempted to report preliminary
results on the side effect profile of LB in patients undergoing posterior laminectomy and
instrumented spinal fusion procedures. Our secondary outcomes were to determine the
readmission rates for pain (potential rebound pain phenomenon) and length of stay (LOS).

Materials/Methods: A retrospective review of posterior decompression and instrumented spinal
fusion procedures from Decemeber 2015 through July 2016 in which LB was used for pain
management was performed (N=33) and compared to a placebo cohort of patients who received
sterile saline in similar procedures (N=21) from an ongoing prospective trial. The study cohort had a
mean age of 60.8 years, equivalent to the mean age of 61.5 years in the control group (p=0.825)
and the BMI was also equivalent (29.7kg/m2 versus 31.1kg/m2, p=0.402). Both cohorts were
similar with the number of decompressed (3.30 versus 3.71; p=0.151), and number fused vertebrae
(2.91 versus 2.38; p=0.053).

Results: We found no significant difference in the rates of complications between study and control
groups including surgical site infections requiring antibiotics 6.1% versus 0% (OR=3.4, 95% CI of 0.2
to 74; p=0.4355), hypotension of less than 90mmHg systolic 21.2% versus 14.3%(OR=1.6, 95% CI of
0.37 to 7.1; p=0.53), or urinary retention requiring a straight catheter or replacement of Foley
catheter 12.1% versus 14.3%(OR=1.3, 95% CI of 0.30 to 6.0; p=0.71), respectively. There was a
significant difference between the study and control groups in regards to nausea and/or emesis:
36.4% vs 9.52%(OR=5.4, 95% CI of 1.1 to 27; p=0.041).

Discussion/Conclusion: The addition of LB for patients undergoing surgical procedures did not lead
to increased rates of complication, with the exception of nausea and/or emesis. While the
increased rate of nausea and/or emesis was significant, further higher powered studies will be
necessary to make more definitive conclusions on this significance given the large uncertainty seen
in the CI.

184
Poster 19

A Comparison of Anterior and Posterior Lumbar Interbody Fusions– Complications,
Readmissions, Discharge Dispositions and Costs

RABIA QURESHI, BS1, Varun Puvanesarajah, BS2, Amit Jain, MD3, Adam Shimer, MD2, Francis Shen,
MD4, Hamid Hassanzadeh, MD2
1
, CHARLOTTESVILLE, VA, 2, Charlottesville, VA, 3, Baltimore, MD, 4, Charlottesville, Virginia

Background/Introduction: Indications for anterior (ALIFs) vs posterior lumbar interbody fusions
(PLIFs) can vary, though benefits of anterior approach surgery include full access to the anterior
column and ability to place fusion devices. No large scale investigation has been conducted to
understand medical complication rates, readmission rates, costs and discharge dispositions in ALIFs
versus TLIF/PLIFs for lumbar degenerative disease.

Materials/Methods: The PearlDiver Database of Medicare records was utilized. A study group
consisting solely of ALIF procedure patients was selected for. Similarly, a TLIF/PLIF group was
selected for. Both groups were queried for comorbidities, 30 and 90-day complication and
readmission rates. Additionally, discharge dispositions, and in-hospital/30-day/90-day Medicare
reimbursements were determined.

Results: At both 30 and 90 days postoperatively odds of ileus, wound infection and lower extremity
DVT were significantly increased in the ALIF. However, unadjusted rates and adjusted odds of
transfusion or dural tear were significantly decreased in the ALIF patients. Odds of 30-day
readmission were 4 times higher in ALIF patients. Additionally, 30 and 90-day total costs of care in
ALIF patients were significantly increased by approximately $4800 and $5800 respectively, as
compared to patients undergoing TLIF/PLIF.

Discussion/Conclusion: Despite higher initial routine discharge rates, readmissions and costs of
postoperative care were significantly increased in ALIF procedures. It is necessary to evaluate
etiology of degenerative pathology as ALIFs are successful solutions to anterior translational
instability and anterior disc slippage, but may not have the best long-term outcomes and may not
be cost-effective compared to a TLIF/PLIF. In light of our data, it is important to assess the risks and
benefits of the varying approaches, and the necessity to access the anterior column, when deciding
on surgical technique to treat lumbar degenerative pathology.
185

186
Poster 20

Postoperative Complications in Orthopaedic Spine Surgery- Is There a Difference Between Males
and Females?

Jessica Heyer, MD1, Na Cao, BS, MS2; Raj Rao, MD3
1
George Washington University Hospital, Washington , DC, 2George Washington University
School of Medicine, Washington , DC , 3George Washington University, Washington , DC

Background/Introduction: Gender has previously been shown to have an impact on outcomes
following surgical intervention. There is little data on the impact of gender on postoperative
outcomes following spine surgery. Prior studies have utilized the National Surgical Quality
Improvement Program (NSQIP) database to report outcomes of various spine surgeries. There are
no studies that specifically look at the impact of gender difference across all spine procedures.

Materials/Methods: The NSQIP database was queried for patients undergoing spine surgery
performed by an orthopedic surgeon from 2005-2014. Thirty-day postoperative data was analyzed
to determine the differences in outcomes and complications between genders.

Results: 41,315 patients (49.0% females) were included. Female patients were older than male
patients (57.3 years vs. 56.1, p<0.001). Male patients were more likely to have diabetes (15.4% vs.
14.4%, p=0.004), require dialysis (3.8% vs. 2%, p<0.001), drink at least two alcoholic beverages a
day (5.2% vs 1.1%, p<0.001), have a history of cardiac surgery (5.6% vs. 2.1%, p<0.001,
percutaneous coronary intervention (7.6% vs. 3.0%, p<0.001), and peripheral vascular disease
requiring surgical intervention (1.2% vs. 0.6%, p=0.001). Females, however, were more likely to
taking steroids for a chronic medical condition (4.3 vs. 3.0, p<0.001). Postoperatively, female
patients were at increased risk for superficial surgical site infection (SSSI)(0.92% vs. 0.70%, p=0.014)
and urinary tract infection (UTI)(1.96% vs. 0.89%, p<0.001), while males were at increased risk for
pneumonia (0.92% vs. 0.71%, p=0.018) and unplanned intubation (0.60% vs. 0.41%, p=0.007).
Females more frequently required transfusions (12.7% vs. 8.4%, p<0.001), and had longer hospital
lengths of stay (LOS) (3.5 days vs. 3.0 days, p<0.001). This was confirmed by multivariate analysis.
When controlling for preoperative comorbidities, female gender was an independent risk factor for
postoperative transfusions (p<0.001), UTI (p<0.001), and SSSI (p=0.045).

Discussion/Conclusion: Present data finds that males and females have different preoperative co-
morbidities and are at risk for different complications postoperatively (males -pneumonia,
reintubation; females - UTI, SSSI, transfusions). Females had increased LOS, despite fewer
preoperative comorbidities. With this knowledge, targeted preemptive strategies for males and
females undergoing spine surgery can be effective in preventing postoperative complications and
lead to reduced hospital LOS.

187
Poster 21

Operative Approaches for Lumbar Disc Herniation: A systematic review and multiple treatment
meta-analysis of conventional and minimally invasive surgeries.

Mohammed Ali Alvi, MD1, Daniel Shepherd, M.D.2, Jang Yoon, MD3, Panagiotis Kerezoudis, M.D.1,
Mohamad Bydon, M.D.4
1
Mayo Clinic, Rochester, MN, 2Mayo Clinic, Rochester, MN, Rochester , MN, 3Mayo Clinic,
Jacksonville, Florida, 4, Rochester, MN

Background/Introduction: Since the late 1920s, many surgical procedures have been defined to
operate on lumbar disc herniation, the Gold-Standard among them being open discectomy (OD)
and Microdiscectomy (MD). In the last two decades, many minimally invasive procedures have
been introduced such approaches have been defined which include percutaneous (PD),
percutaneous endoscopic (PED) and tubular discectomy (TD).

Materials/Methods: Following the PICO approach, and PRISMA guidelines for literature search and
conforming to GRADE guidelines for our outcome analyses, we identified 14 studies and performed
a multiple treatment meta-analysis whereby we compared one surgical approach to 3 other
approaches in the form of direct and indirect subgroup analysis.

Results: We found low-quality evidence that OD/MD is associated with significantly better post-
operative disability as assessed by ODI score at Last follow-up (Mean Difference (MD) 2.61, 95% CI
0.88 to 4.35; p= 0.03). Similarly, TD was found to be associated with significantly worse ODI scores
at 1 year (MD 1.17, 95% CI 0.10 to 2.24; p=0.03). In terms of surgical outcomes, OD/MD was found
to be associated with significantly longer duration of stay ( (MD 2.96, 95% CI 0.20 to 5.72; p=0.04)
and more blood loss (MD 30.53, 95% CI 16.58 to 44.47; p= <0.00001). In terms of complications, TD
was found to be associated with significantly higher incidence of Dural tears (OR 1.72, 95% CI 0.99
to 2.97; p=0.04). Finally, OD/MD was found to be associated with significantly lower incidence of
re-operation (OR 0.53, 95% CI 0.36 to 0.76; p= 0.0007).

Discussion/Conclusion: OD/MD results in significantly improved post-operative disability, while TD
and PED were found to be associated with shorter length of stay, less blood loss.

188
Poster 22

Comorbid Conditions as Predictors of Postoperative Outcome Following Lumbar Spine Surgery: a
Survey of United States Orthopaedic and Neurological Surgeons

Heath Gould, B.S.1, Jeffrey O'Donnell, B.S.2, Vince Alentado, M.D.2, Colin Haines, M.D.3, Jason
Savage, M.D.4, Thomas Mroz, M.D.5
1
, North Las Vegas, Nevada, 2, Cleveland, Ohio, 3, Reston, Virginia, 4The Cleveland Clinic,
Cleveland, Ohio, 5Cleveland Clinic Foundation, Neurological Institute, Cleveland, OH

Background/Introduction: There remains a lack of consensus among surgeons regarding the value
of common comorbidities as predictors of poor postoperative outcome. The present study seeks to
better characterize this discordance by eliciting surgeons’ beliefs in the form of a nationally-
distributed survey.

Materials/Methods: An electronic survey was distributed to 2366 orthopaedic and neurological
surgeons throughout the United States. Respondents were asked to use a 5-point Likert scale to
rate the value of five comorbidities in predicting poor postoperative outcome following lumbar
spine surgery.

Results: 341 surgeons completed the survey (14.4%), including 254 orthopaedic surgeons and 86
neurological surgeons. Psychosocial complications and chronic narcotic use were deemed “strong”
predictors of poor postoperative outcome, with mean Likert values of 4.2 and 4.1, respectively.
Smoking and obesity were designated as “moderate” predictors, with mean values of 3.3 and 3.2,
respectively. Diabetes was assigned a “weak” predictive value of 2.8 on the 5-point scale. Obesity
was the greatest source of discrepancy between groups of responding surgeons. Orthopaedic
surgeons assigned a significantly lower predictive value to obesity than neurological surgeons (3.1
vs. 3.4, p=0.004). Similarly, surgeons practicing in a hybrid setting deemed obesity significantly less
predictive of postoperative outcome than surgeons in a private practice or academic center (2.9 vs.
3.2, p=0.017; 2.9 vs. 3.4, p=0.002). Fellowship-trained surgeons also rated obesity lower on the
Likert scale than surgeons who were not fellowship-trained, although this difference did not reach
significance (3.1 vs. 3.3, p=0.074). In addition to obesity, narcotics and diabetes generated
significant disagreement among responding surgeons when stratified by level of experience. Less
experienced surgeons assigned a significantly higher predictive value to narcotic use compared to
their more experienced colleagues (p=0.005). Surgeons practicing for 10-20 years rated the
predictive value of diabetes significantly lower than either their more experienced or less
experienced counterparts (p=0.023).

Discussion/Conclusion: Surgeons showed consensus with respect to the role of smoking and
psychosocial complications in predicting postoperative outcome, but opinions varied widely
regarding obesity, diabetes, and narcotic use. Further studies are needed to determine whether
the comorbidities with the highest Likert ratings are indeed the strongest predictors of poor
postoperative outcome.

189
Poster 23

High Risk Subgroup Membership as a Risk Factor for Post-Operative Complications after Posterior
Lumbar Fusion

Jun Kim, MD1, John Di Capua, MHS, BS2, Sulaiman Somani, BS2, Rachel Bronheim, BA1, Nathan Lee,
BS2, Parth Kothari, BS2, Deepak Kaji, BS3, Samuel Cho, MD4
1
, New York, NY, 2Icahn School of Medicine at Mount Sinai, New York, New York, 3, New York,
New York, 4, NY, NY

Background/Introduction: Posterior Lumbar Fusion (PLF) is a common procedure used to treat
spinal deformities and degenerative disorders. It is unclear how specific subpopulations differ from
the general surgical population in operative outcomes.

Materials/Methods: This is a retrospective analysis of data from the ACS-NSQIP database from
2010-2014 for patients undergoing PLF. Demographic, comorbidity, and postoperative variables
were collected on 6 subgroups: elderly (>=65 years), Caucasian vs. Non-Caucasian, obese (BMI >=30
kg/m2), renal insufficiency, emergent, and cancer patients. Multivariate regression was utilized to
determine whether subgroup membership was an independent predictor of complications.

Results: 24,202 patients met the study inclusion criteria, 42% of which were elderly, 84.2% of
which were white, 48.5% of which were obese, 0.6% of which had cancer, 0.2% of which had renal
insufficiency, and 0.7% of which were emergent procedures. Multivariate logistic regression (Table
1) found that the elderly subgroup was at increased risk for UTI (OR=1.99(1.57-2.51),p<0.0001),
cardiac complications (OR=1.61(1.01-2.57),p=0.047), and unplanned readmission (OR=1.16(1.01-
1.34),p=0.041). Advanced age was associated with a reduced risk for increased operative time
(OR=0.84(0.783-0.896),p=<0.0001), increased LOS (OR=0.791(0.841-0.973),p=0.007), and wound
complications (OR=0.791(0.649-0.964),p<0.020). Non-Caucasian ethnicity was a predictor of
increased operative time (OR=1.20(1.11-1.29),p=<0.0001) and increased LOS (OR=1.55(1.42-
1.68),p=<0.0001). Obese patients had a greater risk of increased operative time (OR=1.27(1.20-
1.35),p=<0.0001), wound complications (OR=1.45(1.21-1.75),p=<0.0001), renal complications
(OR=2.60(1.45-4.68),p=0.001), reoperation (OR=1.17(1.00-1.36),p=0.048), and unplanned
readmission (OR=1.14(1.00-1.30),p=0.046), as well as a reduced risk of postoperative blood
transfusion (OR=0.922(0.854-0.995),p=0.037). Renal insufficiency was a predictor of increased LOS
(OR=2.93(1.61-5.33),p=<0.0001), renal complications (OR=4.90(1.02-23.6),p=0.048), blood
transfusion (OR=2.22(1.22-4.05),p=0.009), sepsis (OR=3.51(1.18-10.5),p=0.024), reoperation
(OR=3.07(1.35-6.99),p=0.008), and unplanned readmission (OR=2.53(1.17,5.45), p=0.018). Cancer
was associated with greater risk for increased operative time (OR=1.73(1.21-2.46),p=0.003),
increased LOS (OR=9.74(6.21-15.3),p=<0.0001), wound complications (OR=2.18(1.07-
4.43),p=0.032), postoperative blood transfusion (OR=2.90(2.02-4.16),p=<0.0001), sepsis
(OR=2.75(1.07-7.06),p=0.036), and mortality (OR=7.77(2.00-30.2), p=0.003). Emergent procedures
associated with an increased risk of LOS (OR=3.74(2.68-5.23),p=<0.0001), renal complications
(OR=8.54 (2.51-29.1),p=0.001), reoperation (OR=2.56,(1.43-4.60),p=0.002), unplanned readmission
(OR=2.44,(1.43-4.15),p=0.001), and mortality (OR=5.73,(1.17-28.1), p<0.031).
190

Discussion/Conclusion: This study found that advanced age, non-Caucasian ethnicity, obesity, renal
insufficiency, cancer, and emergent procedures are independent predictors of postoperative
morbidity and mortality following PLF. This demonstrates the importance of nested subgroup
analysis within large populations for uncovering clinically relevant risks of selected patients and for
identifying quality improvement goals.

191
Poster 24

Impact of sarcopenia on outcomes following elective lumbar fusion

Doniel Drazin, MD, MA1, Christopher Kong, MD2, Miriam Treggiari, MD3, Robert Hart, M.D.4
1
Swedish Neuroscience Institute, Seattle, WASHINGTON, 2Oregon Health & Science University,
Portland, Oregon, 3, Seattle, Washington, 4Oregon Health and Science University, Portland, OR

Background/Introduction: Sarcopenia, loss of skeletal muscle mass and function, has been
measured by total psoas area (TPA). In other surgical specialties, significant associations were
found between low TPA and increased postoperative complications.

Materials/Methods: From January 2007 to June 2011, adults undergoing elective lumbar fusion
were included in a retrospective study aimed to assess the impact of TPA on their surgical
outcomes. The axial series of each patient’s lumbar CT scan was analyzed using 8 reference points
with TPA calculated automatically, then divided by their height in meters squared. Primary
endpoint was any major complication within 30 days post-operative. Hospital length of stay (LOS)
and ICU LOS were recorded. Baseline demographic characteristics were described in univariate
analysis. Multivariable linear regression estimated the effect of TPA on post-operative
complications, adjusting for potential confounders.

Results: Of 326 patients studied, most were female (n=219, 67%). Mean age: 59 (SD: 14.5). Average
number of levels fused: 3.8. Median TPA/m2 was 626.1 (IQR: 538.6, 769.2) mm2/m2 in males and
465.9 (IQR: 392.0, 576.9) mm2/m2 in females. Patients with below median TPAs were older for
women (p=0.06), and significantly older for men (p<0.01). Women with low TPAs had significantly
higher risk of arrhythmia (p<0.01). In analyses, women in the lowest TPA quartile had higher risk of
overall complications (p=0.06). In multivariable logistic regression analysis, age was a significant
predictor of complications, but TPA was not associated with complications. Hospital LOS (but not
ICU LOS) was longer for women with lowest TPAs.

Discussion/Conclusion: This is one of the first studies looking at sarcopenia in spinal deformity
patients. Median TPA was higher than previously reported sarcopenia thresholds, suggesting that
women in the lowest TPA quartile have heightened risks for serious post-operative complications
and prolonged hospital LOS. Further investigation should focus on interventions to improve
postoperative outcomes.

192
Poster 25

The Impact of Sciatica on United States Medicare Recipients

Tyler Jenkins, M.D.1, Joseph Maslak, M.D.2, Daneel Patoli, B.S.3, Wellington Hsu, M.D.4, Alpesh Patel,
MD, FACS5
1
Northwestern University - Feinberg School of Medicine, Chicago, IL, 2Northwestern University -
Feinberg School of Medicine, Chicago, Il, 3, Chicago, IL, 4Northwestern Memorial Hospital,
Chicago, Illinois, 5Northwestern University, Chicago, IL

Background/Introduction: The Medicare Healthcare Outcomes Survey (HOS) is an annual
demographic and patient outcomes survey used to monitor the performance of Medicare
Advantage health plans in the U.S. The HOS consists of questions regarding baseline demographics,
chronic medical conditions, and incorporates the Veterans Rand-12 (VR-12) patient-reported
outcomes tool. The VR-12 is a health survey that is used to measure health related quality of life
and to evaluate disease-specific impact. VR-12 outcomes are reported with two summary scores,
the physical component score (PCS) and the mental component score (MCS). We analyzed the
Medicare HOS data on over 1 million patients to evaluate the disease burden of sciatica on the U.S.
Medicare population.

Materials/Methods: Medicare HOS data was obtained. Patients were placed into 2 categories
based upon survey results: history of sciatica or no history of sciatica. Baseline demographics,
chronic medical conditions, and average VR-12 scores were calculated for each group at baseline
and at 2 years follow-up. All analysis was completed with significance set at p < 0.0001.

Results: The baseline cohort data of 1,000,952 patients yielded 250,869 (25%) patients who
reported the diagnosis of sciatica. Patients with a history of sciatica tended to be younger, less
educated, and with significantly more medical comorbidities. The VR-12 outcomes were
significantly lower in patients with sciatica at both baseline and 2 year follow-up. PCS outcomes
were approximately 8 units lower in the sciatica group at baseline and 7 units lower at 2 year
follow-up. MCS outcomes were 6 units lower in the sciatica group at baseline and 5 units lower at 2
year follow-up. Validated literature on the VR-12 has shown a change as small as 1-2 units to be
clinically and socially relevant.

Discussion/Conclusion: Medicare patients who report a diagnosis of sciatica have significantly
more medical comorbidities and significantly lower VR-12 scores. Lower VR-12 outcomes have
been shown to negatively impact health care costs, pharmacy expenditure, and rate of healthcare
utilization. This study illustrates that sciatica is a large health burden in the U.S. Medicare
population. Early diagnosis and treatment of sciatica in needed to improve the health-related
quality of life in this population.

193

194
Poster 26

Anemia as a Risk Factor for 30-Day Postoperative Complications Following Elective Anterior
Lumbar Fusion Surgery

William Ranson, BS1, Chierika Ukogu, BA1, Samantha Jacobs, BA2, John Di Capua, MHS, BS3,
Sulaiman Somani, BS3, Jun Kim, MD1, Yi Hong Zheng, BA, Molecular and Cell Biology4, Samuel Cho,
MD5
1
New York, 4, Pico Rivera, California, 5, NY, NY

Background/Introduction: Introduction: Approach related complications of anterior lumbar fusion
(ALF) have been well-studied and are distinct from those of posterior approaches to the lumbar
spine, and they relate to visceral or vascular injury. However, it is not clear how anemic
characteristics in the patient affect adverse outcomes. The aim of this study is to elucidate the risk
of mortality and serious postoperative morbidities in anemic patients undergoing ALF.

2014 for patients undergoing PLF surgery. Patients were identified by CPT code corresponding to
PLF surgery. Patients with age <18 years, non-elective surgery, emergency surgery, current
pneumonia, current sepsis, current pregnancy, wound class >1, or a previous operation within 30
days of the principal operation were excluded from the study. Patients were categorized as anemic
if they had preoperative hematocrit <36.0 for females and <39.0 for males. Multivariate logistic
regression models were employed, adjusting for patient demographic, preoperative and
intraoperative variables, to determine the effect of patient anemia on 30-day postoperative
complications.

Results: Results: 2,930 cases met the inclusion criteria for this study of which 406 (13.9%) displayed
anemic characteristics. Univariate analysis showed the following characteristics in patients with
anemia: < 65 years of age, diabetes, pulmonary, cardiac, and renal comorbidities, black, dyspnea,
dependent functional status, bleeding disorders, preoperative RBC transfusion, and ASA Class ≥ 3.
Multivariate logistic regression revealed anemia was a risk factor for increased length of stay
(OR=1.64, 1.28-2.09), renal complication (OR=9.50, 1.58-57.01), and intraoperative or
postoperative RBC transfusion (OR=3.29, 2.42-4.47).

Discussion/Conclusion: Conclusion: Anemia is significantly associated with a length of stay ≥ 5
days, postoperative renal complication, and intra or postoperative RBC transfusion. Consideration
of these risk factors can help ensure appropriate evaluation and preoperative condition
optimization leading to a decrease in the probability of a potentially fatal adverse outcome in
patients.

195

196
Poster 27

Assessment of Demographic, Preoperative, and Intraoperative Risk Factors for Cardiac Arrest
Following Elective Posterior Lumbar Fusion Surgery

Sulaiman Somani, BS1, Jun Kim, MD2, John Di Capua, MHS, BS1, Samantha Jacobs, BA3, Chierika
Ukogu, BA2; William Ranson, BS2, Chuma Nwachukwu, BA2, Samuel Cho, MD4
1
Icahn School of Medicine at Mount Sinai, New York, New York, 2, New York, NY, 3, New York,
New York, 4, NY, NY

Background/Introduction: Introduction: Posterior lumbar fusion (PLF) is indicated in a wide range
of degenerative conditions. As the number of individuals undergoing PLF surgery increases every
year, it is important to assess characteristics with the potential to cause adverse postoperative
outcomes. This study seeks to assess demographic, preoperative, and intraoperative characteristics
as risk factors for myocardial infarction following PLF surgery.

2014 for patients undergoing posterior lumbar fusion surgery. Patients were identified by CPT code
corresponding to PLF surgery. Patients with age <18 years, non-elective surgery, emergency
surgery, current pneumonia, current sepsis, current pregnancy, wound class >1, or a previous
operation within 30 days of the principal operation were excluded from the study. Patients who
suffered cardiac arrest necessitating CPR either during the surgical procedure or up to 30 days post-
operation were included in the study. Multivariate logistic regression models were employed,
adjusting for patient demographic, preoperative and intraoperative variables, to determine the
effect of patient characteristics on cardiac arrest.

Results: Results: 22,911 cases met the inclusion criteria for this study of which 31 (0.14%)
experienced cardiac arrest during or up to 30 days after undergoing PLF surgery. Multivariate
logistic regression (c-statistic=0.646) revealed recent weight loss (OR=9.67, 1.18-79.42), bleeding
disorder (OR=5.11, 1.51-17.25), preoperative RBC transfusion (OR=18.39, 2.21-152.75) and ASA
classification ≥ 3 (OR=2.36, 1.07-5.19) to be predictive factors for cardiac arrest following PLF.

Discussion/Conclusion: Conclusion: ASA classification ≥ 3, preoperative transfusion of ≥ 1 unit of
whole/packed RBCs, bleeding disorders, and weight loss of >10% of body weight within 6 months
were associated with cardiac arrest during surgery or during the 30 days following a PLF procedure.
Consideration of these risk factors can help ensure appropriate evaluation and preoperative
condition optimization leading to a decrease in the probability of a potentially fatal adverse
outcome in patients.

197

198
Poster 28

Metabolic Syndrome is Associated with Increased Wound Complications and Urinary Tract
Infections after Lumbar Fusion: a Propensity Score-Matched Analysis

Francis Lovecchio, MD, Michael Fu, MD, Sravisht Iyer, MD, Todd Albert, MD
Hospital for Special Surgery, New York, NY

Background/Introduction: Metabolic syndrome (MetS) is a distinct state of metabolic dysfunction,
generally agreed on as a combination of visceral obesity, insulin resistance, hypertension, and
hyperlipidemia. The syndrome is increasingly prevalent in patients undergoing spinal fusion.
Understanding its independent effect on perioperative outcomes will optimize preoperative risk
stratification and reduction in this high-risk cohort of patients. The purpose of this study is to
quantify the independent effect of metabolic syndrome on rates of complications, readmissions,
and prolonged length of stay (LOS) after elective lumbar spine fusion.

Materials/Methods: One- to three-level posterior spinal fusion cases were identified from the
2011-2014 ACS-NSQIP. To eliminate baseline differences between patients with and without
metabolic syndrome, propensity scores based on demographics, comorbidities, presence of
interbody fusion, number of levels, and diagnosis were used to match patients with and without
metabolic syndrome in a 1:1 ratio. Outcomes of interest were compared between the cohorts.
Logistic regression with propensity score adjustment was further utilized as a secondary method of
reducing selection bias.

Results: Out of 18,605 patients that met criteria for inclusion, 1903 (10.2%) met our definition of
metabolic syndrome. After matching, patients with MetS had a higher rate of wound complications
(3.7% vs. 2.6%, p=0.035), urinary tract infections (3.1% vs. 1.7%, p=0.004), and extended LOS
(29.1% vs. 23.5%, p<0.001). Logistic regression confirmed that patients with MetS were almost
twice as likely to experience a UTI (O.R. 1.91, 95% C.I. 1.24-2.96) and one-and-a-half times as likely
to experience a wound complication (O.R. 1.47, 95% C.I. 1.02-2.12). Rates of any medical
complication and readmission were comparable between the two cohorts.

Discussion/Conclusion: Patients with metabolic syndrome who are considering elective spine
surgery should be aware of a higher risk for wound complication, UTI, and long length of stay.
Clinicians may want to consider medical optimization prior to elective surgery.

199
Poster 29

Safety and Outcomes Following Anterior versus Posterior Lumbar Interbody Fusion Procedures

Jamal Shillingford, MD1, Joseph Laratta, MD1, Joseph Lombardi, MD1, John Mueller, BS2, Charla
Fischer, MD3, Ronald Lehman, MD4
1
, New York, NY, 2, New York, New York, 3Columbia University Department of Orthopaedic
Surgery, New York City, New York, 4, New York, NY

Background/Introduction: Controversy exists over the ability of various lumbar interbody fusion
techniques to realign global and regional balance, as well as affect patient outcomes.

Materials/Methods: Our retrospective cohort utilizing the NSQIP database included 2372 (29.9%)
single-level anterior/lateral interbody fusions and 5563 (70.1%) single-level
posterior/transforaminal interbody fusions between 2013 and 2014. Emergent cases, fracture
cases, and preoperative compromised wounds were not included in the analysis. Primary thirty-day
outcomes included mortality, return to operating room, readmission, length of stay, and other
major complications. Minor outcomes included urinary tract infection, superficial incisional site
infection, and perioperative blood transfusion within 72 hours.

Results: Anterior/lateral fusion techniques were performed more often in patients with
degenerative lumbar disc disease (31.0% vs. 13.9%, p<0.001), whereas posterior techniques were
utilized more for patients with spondylolisthesis (19.1% vs 24.4%, p<0.001). Length of hospital stay
and mean operation time were significantly longer statistically in the posterior group (3.6+ 4.3 days
vs. 3.4 + 4.2 days, p<0.05) and (200.2+ 94.4 minutes vs. 192.0 + 112.8 minutes, p=0.001) though
these differences are clinically insignificant. Thirty-day mortality was significantly higher for the
anterior group (0.3% vs. 0.1%, p =0.021)). Significantly more patients in the posterior group
required blood transfusions within 72hours of surgery (9.6% vs. 7.6%, p=0.005). Elevated American
Society of Anesthesiologists (ASA) physical status classification, increased age >60, prior bleeding
disorder, and preoperative anemia were significantly associated with the need for blood
transfusion.

Discussion/Conclusion: Although numerous techniques can be utilized in the treatment approach
to various lumbar pathologies, anterior approaches have an increased risk of early mortality.
Transfusion risk is more strongly associated with elevated ASA class, increased age, preoperative
anemia, and patients with bleeding disorders.

200

201
Poster 30

Association between Allogeneic Blood Transfusion and Postoperative Infection in Major Spine
Surgery

Christian Fisahn, MD1, Shiveindra Jeyamohan, MD1, Daniel Norvell, PhD2, R. Tubbs, PhD3, Marc
Moisi, MD1, Jens Chapman, MD4, Jeni Page, ACNP-BC1, Rod Oskouian, MD4
1
Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, 2Spectrum
Research, Inc., Tacoma, Washington, 3Seattle Science Foundation, Seattle, Washington, 4, Seattle,
WA

Background/Introduction: Postoperative infections increase morbidity and mortality rates in spine
surgery and generate additional costs for the healthcare system. It has been proposed that blood
transfusions increase the risk of wound infection, urinary tract infection, pneumonia, and sepsis.
The aim of this study was to determine the incidence of infection in patients who received blood
transfusions in major deformity surgery involving at least eight levels, hypothesizing that
transfusions are a risk factor for postoperative infection.

Materials/Methods: A retrospective cohort study conducted from 2012 to 2015 identified 56
patients meeting the study criteria who had received spine surgery involving the fusion of eight
levels or more. Patient-specific characteristics, starting and ending hematocrits, number of units
transfused, use of vancomycin powder, drain usage, and infections including urinary tract infection,
wound infection, pneumonia, Clostridium difficile, and sepsis were documented. Differences in
infection risk between those who did and did not undergo a transfusion and their 95% confidence
intervals were calculated.

Results: Groups were similar with respect to baseline and surgical characteristics except for
smoking status, operative time, estimated blood loss, and ending hematocrit. The overall infection
rate was greater in patients who underwent transfusion than those who did not (36% versus 10%; p
= 0.03). Wound infections (n = 5) were only observed in those who underwent a transfusion.
Smokers were more likely to receive a transfusion and were also more likely to experience
infection. A stratified analysis demonstrated an increased risk of infection associated with
transfusion; however, the risk was greater in smokers, suggesting the effect of transfusion on
infection could be modified by smoking. Patients undergoing transfusion experienced a significantly
longer hospital stay (p = 0.01).

Discussion/Conclusion: Allogeneic red blood cell transfusion in major spine surgery could be a risk
factor for postoperative infection. This increased risk seems to be magnified in those who smoke.
Further studies are warranted, and risks of blood loss and transfusion-related complications in
smokers also potentially merit exploration.

202
Poster 31

Predictors of Complications and Readmission following Spinal Stereotactic Radiosurgery

Daniel Lubelski, M.D.1, Joseph Tanenbaum, BS2, Taylor Purvis, BS3, Thomas Bomberger, BA4, C. Rory
Goodwin, M.D./Ph.D.5; Daniel Sciubba, M.D.5
1
Johns Hopkins Hospital, Baltimore, MD, 2Case Western Reserve University School of Medicine,
Cleveland, Ohio, 3Johns Hopkins School of Medicine, Baltimore, MD, 4, Cleveleand Heights, OH,
5
Johns Hopkins Hospital, Baltimore, Maryland

Background/Introduction: Stereotactic radiosurgery (SRS) is increasingly used for treatment of
spinal tumor. It is currently unclear what baseline demographic factors predict post-treatment
outcomes. The objective of the present study was to identify preoperative factors associated with
major morbidity, mortality, increase hospital length of stay (LOS), 30 day readmission and
operation rates following SRS for spinal tumors.

Materials/Methods: The American College of Surgeons National Quality Improvement Program
(NSQIP) was queried from 2012 to 2014 to identify all adult patients that underwent SRS for spinal
tumors. Univariate analysis was used to identify potential predictive variables, multiple imputation
was performed to account for missing data. Multivariable logistic regression was used to identify
independent statistically significant predictors of post-treatment outcomes.

Results: 2714 patients were identified that met inclusion criteria. 184 patinets (6.8%) had “major
morbidity or mortality,” 193 (7.1%) had a major morbidity, 186 (6.9%) were readmitted within 30
days, and 116 (4.3%) had a subsequent operation within 30 days. Age, BMI, and ASA class were
predictive of LOS. Major morbidity was predicted by age greater than 80, BMI>35, high ASA class,
as well as pre-treatment functional dependence and other baseline comorbidities. Predictors of
operation within 30 days included preoperative steroid use, renal failure, BMI>35, and if the
treatment was non-elective.

Discussion/Conclusion: The data herein demonstrate that 4-7% of patients undergoing SRS for
spinal tumors have morbidity following the procedure. A large percentage of this is likely
attributable to baseline patient characteristics and severity of their oncologic disease. Factors that
are independently predictive of morbidity, increased length of stay, and subsequent operation
included age, BMI, and baseline comorbidities and functional status. Identification of preoperative
patient-specific factors that are predictive of post-treatment outcome will aid in patient selection
and patient counseling leading to greater patient satisfaction and hospital efficiency.

203
Poster 32

Evaluating the Effect of Growing Patient Numbers and Changing Data Elements in the National
Surgical Quality Improvement Program (NSQIP) Database Over the Years: A Study of Lumbar
Fusions

Blake Shultz, B.A.1, Patawut Bovonratwet, BS2, Nathaniel Ondeck, B.S.3, Taylor Ottesen, B.S.4, Ryan
McLynn, B.S.1, Jonathan Cui, B.S.1, Jonathan Grauer, MD3
1
New Haven, CT, 4Yale University School of Medicine, New Haven, CT

Background/Introduction: The use of national databases in spinal surgery outcomes research is
increasing. However, there has been limited study evaluating the effect that the addition of
patients and evolving data elements in databases such as the American College of Surgeons
National Surgical Quality Improvement Program (NSQIP) may have on the results of outcomes
studies. A number of variables collected by NSQIP changed between 2010 and 2011, coinciding
with a rapid increase in the number of patients included per year. The current study aimed to
investigate the effects of these changes on results of lumbar fusion studies.

Materials/Methods: The NSQIP database was retrospectively queried to identify 19,755 patients
who underwent elective posterior lumbar fusion surgery +/- interbody fusion between 2005 and
2014. These patients were split into two groups based on year of surgery: 2,802 from 2005-2010
and 16,953 from 2011-2014. Preoperative characteristics and perioperative outcomes were
compared between the era groups using bivariate analysis. As an example evaluation of the effect
of such changing data elements, the association between age and postoperative outcomes in the
two era groups was analyzed using multivariate Poisson regression.

Results: There were significant differences between the era groups for preoperative factors such as
age, smoking status, alcohol use, ASA class, BMI, rates of cardiac and neurological comorbidity, and
functional status. Postoperative events such blood transfusion and deep vein thrombosis were also
significantly different between the era groups. For the 2005-2010 cohort, age was significantly
associated with septic shock by multivariate analysis. However, for the 2011-2014 cohort, age was
significantly associated with septic shock, urinary tract infection, blood transfusion, myocardial
infarction, and extended length of stay.

Discussion/Conclusion: The NSQIP database has undergone substantial changes between 2005 and
2014. Preoperative characteristics and perioperative outcomes have changed between older years
(2005-2010) and newer years (2011-2014). These changes may contribute to different results in
analyses such as the association between age and postoperative outcomes when using older versus
newer data. Moving forward, it may be appropriate to limit NSQIP studies to later years.

204
Poster 33

Total Disc Arthroplasty and Anterior Interbody Fusion in the Lumbar Spine Have Relatively
Similar Short-Term Outcomes

Blake Shultz, B.A.1, Alexander Wilson, B.S.2, Nathaniel Ondeck, B.S.2, Patawut Bovonratwet, BS3,
Ryan McLynn, B.S.1, Jonathan Cui, B.S.1, Jonathan Grauer, MD2
1
Yale School of Medicine, New Haven, Connecticut, 2, New Haven, CT, 3Yale School of Medicine,
New Haven, CT

Background/Introduction: Lumbar total disc arthroplasty (TDA) and anterior lumbar interbody
fusion (ALIF) may be considered for similar degenerative indications. However, there have been
few large-cohort comparison studies of short-term clinical outcomes for the two procedures. This
study aimed to investigate the short-term general-health outcomes of TDA and ALIF in the
American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

Materials/Methods: The NSQIP database was retrospectively queried to identify 1,801 patients
who underwent elective stand-alone ALIF and 255 cases of elective TDA between 2011-2015. TDA
and ALIF cases were matched for nine preoperative characteristics using propensity scores,
resulting in 255 pairs. The association of procedure type with adverse events was determined for
the matched cohorts using McNemar’s test. Operative time and postoperative length of stay were
compared between procedures using bivariate and multivariate linear regression. Risk factors for
adverse events in both procedures were determined using multivariate Poisson regression.

Results: There were no significant differences in the rates of any adverse event, serious adverse
events or individual adverse events between the matched TDA and ALIF cohorts other than blood
transfusion, which occurred more frequently in the ALIF cohort (3.92% versus 0.39%, p = 0.007).
Operative time was not significantly different between the two cohorts, but postoperative length
of stay was statistically significantly longer for ALIF cases (+0.28 days, p < 0.001). When evaluating
ten preoperative variables as potential risk factors for any, serious, and minor adverse events after
TDA and ALIF, the majority of predictors of adverse outcomes were similar.

Discussion/Conclusion: The only differences in perioperative outcomes between TDA and ALIF
were a 3.53% higher incidence of blood transfusion and 0.28-day longer length of stay for the ALIF
group. These results suggest that overall short-term general-health outcomes between the two
groups were similar, and that the choice between two procedures for the appropriately selected
patient should be based on longer-term functional outcomes.

205
Poster 34

Trends in Resource Utilization for Vertebral Fracture Repair Surgeries in the United States from
2006-2014

Alejandro Cazzulino, Bachelor of Arts1, Comron Saifi, MD2, Melvin Makhni, MD3, Matthew Colman,
MD4, Christopher Dewald, MD5, Ronald Lehman, MD6, Howard An, MD5, Frank Phillips, MD7
1
University of Pennsylvania, Philadelphia, PA, 2Midwest Orthopedics at Rush, Chicago, IL,
3
Columbia University, New York City, Ny, 4Rush University, Chicago, IL, 5Rush University Medical
Center, Chicago, IL, 6, New York, NY, 7, Chicago, IL

Background/Introduction: The primary hypothesis of this study is that the annual volume of
surgeries performed for vertebral fractures (VFX) has increased over the past nine year of the study
period. Surgical trends over time for VFX operations as well as other economic outcomes provide
valuable information for both surgeons and health policy makers. VFX surgeries and associated
economic outcomes were analyzed throughout the United States from 2006-2014.

Materials/Methods: Patient data from the National Inpatient Survey (NIS) database for operative
treatment of VFX from 2006-2014 were included in this study. Demographic and economic patient
data were determined for the procedure based ICD-9 CM code 03.53, which includes all forms of
operative treatment of vertebral fractures except kyphoplasty and vertebroplasty. Outcomes
included annual totals, hospital costs and charges, length of stay (LOS), and rate of routine
discharge.

Results: An estimated 40,877 VFX repair surgeries were performed in the United States from 2006-
2014. The number of procedures per year increased 76% during the course of the study period with
a mean of 4,542 surgeries per year (range: 3,085-6,085). Mean LOS decreased 30% over the same
period with an yearly LOS mean of 12.0 days per patient (range: 9.3-13.9 days). The mean
percentage of patients with routine discharge was 39% (range: 34-46%). The mortality rate of
operative intervention for VFX was 2.5% (range: 1.9-3.3%). The cost of VFX repairs peaked in 2012
at $52,884, and increased 5.2% overall (mean: $47,235; range: $42,104-$52,884). Charges have
increased more rapidly with a 50.3% increase over the study period (mean: $163,147; range:
$116,507-$188,897).

Discussion/Conclusion: Operative management of vertebral fractures has increased by 76% in the
United States from 2006-2014 to 6,085 surgeries per year in 2014. The exact cause of this increase
is unclear but may be associated with increasing rates of osteoporosis in the aging population. LOS
has decreased by 30% over the same time period, and yet both costs and charges have increased.
On average 61% of patients were either discharged to a skilled nursing facilities or had home
nursing, which represents a significant economic burden. Finally, inpatient mortality has remained
relatively constant at 2.5% of all procedures.

206

207
Poster 35

Age as a Risk Factor for 30-Day Postoperative Complications Following Anterior Lumbar Fusion
Chierika Ukogu, BA1, William Ranson, BS1, Samantha Jacobs, BA2, John Di Capua, MHS, BS3,
Sulaiman Somani, BS3, Jun Kim, MD1, Rachel Bronheim, BA1
Samuel Cho, MD1
1
New York

Background/Introduction: Surgical treatment and spinal fusion surgery is indicated for lumbar
spinal diseases commonly observed in elderly patients. It is not clear whether rates of
postoperative complications for anterior lumbar fusion (ALF) differ with age. Considering the
steadily aging population, this study aims to elucidate if risk of mortality and other serious
postoperative complications are associated with age.

Materials/Methods: This study analyzed data from the American College of Surgeons National
Surgical Quality Improvement Program (ACS-NSQIP) database between 2011 and 2014 for patients
undergoing ALF. Patients were included based on ALF specific diagnosis codes. Patients with age
<18 years, non-elective surgery, emergency surgery, current pneumonia, current sepsis, current
pregnancy, wound class >1 or a previous operation within 30 days of the principal operation were
excluded from the study. Patients were categorically divided into four subgroups of age. Univariate
and multivariate logistic regression models were employed to determine the effect of age on
postoperative complications.

Results: A total of 3,184 patients met the inclusion criteria for the study. Age ranged from 19 years
to 90 years old. The first age subgroup consisted of patients less than or equal to 45 years old, the
second between 46 and 52 years, a third group consisted of those between 53 and 60 years, and
finally, a group of patients 61 years old and over. Age Group 1, 2, 3 and 4 contained 905 (28.4%),
572 (17.9%), 614 (19.3%) and 1,093 (34.3%) patients respectively. Multivariate logistic regression
revealed the groupings of age to be independent risk factors for increased length of stay in Group 3
(OR=1.95, 1.46-2.60) and Group 4 (OR=2.95, 2.28-3.82) relative to Group1, transfusion Group 2 vs.
Group 1 (OR=1.73, 1.06-2.83 p-value=0.028), and unplanned readmission in Group 2 vs. Group 1
(OR=2.31, 1.19-4.48, p-value=0.014) as well as Group 4 vs. Group 1 (OR=2.46, 1.32-4.56, p-
value=0.004) (Table 1). All p-values <0.0001 unless otherwise noted.

Discussion/Conclusion: Age is significantly and independently associated with a variety of adverse
postoperative outcomes including increased length of stay, transfusion, and unplanned
readmission for patients undergoing ALF procedures. Providers should counsel elderly patients
accordingly to mitigate age related risks of postoperative complications.

208

209
Poster 36

Differences in reported experience with hospital care in patients undergoing cranial and spinal
operations

Panagiotis Kerezoudis, M.D.1, Elizabeth Habermann, Ph.D.1, Mohammed Ali Alvi, MD1, Jang Yoon,
MD2, Daniel Ubl, B.A.3, Kristine Hanson, MPH1, Mohamad Bydon, M.D.4
1
Mayo Clinic, Rochester, MN, 2Mayo Clinic, Jacksonville, Florida, 3Mayo Clinic, Rochester , MN, 4,
Rochester, MN

Background/Introduction: Patient-centered outcomes have been increasingly mandated by the
Centers for Medicare and Medicaid Services in order to evaluate hospital and physician
performance and affect hospital reimbursement. The aim of this study was to investigate the
differences in patient-reported experience of hospital care for a cranial or spinal operation in a
single institution.

Materials/Methods: We sampled all patients who underwent inpatient, elective cranial and spinal
procedures and completed the Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) survey at a single institution between October 2012 and September 2015.
Univariate analysis was employed to assess the association of the surgical procedure and diagnosis
with various HCAHPS composite measures calculated across nine domains using standard top-box
methodology.

Results: A total of 1484 patients met criteria and returned an HCAHPS survey. Overall, patients
undergoing a cranial procedure gave top-box scores less often in Discharge Information (87.1% vs
93.1%, p-value < 0.001) but more often in Pain Management (66.3% vs 59.6%, p-value = 0.012) and
Global, ie overall hospital rating and recommendation (88.7% vs 84.2%, p-value = 0.013) measures
compared to those receiving a spinal operation. Moreover, patients with a primary diagnosis of
brain or spinal tumor compared to those with degenerative spinal disease and those with other
neurosurgical diagnoses, such as aneurysmal, normal pressure hydrocephalus and movement
disorders, provided top-box scores more often regarding Communication with Doctors (82.7% vs
76.4% vs 75.2%, p-value = 0.039 ), Pain Management (71.8% vs 60.9% vs 59.1%, p-value = 0.002)
and Global Rating (90.4% vs 84.0% vs 87.3%, p-value =0.018).

Discussion/Conclusion: Significant differences in patient-reported experience of hospital care exist
between the different cranial and spine surgery groups. Identifying weaker areas of hospital
performance in target populations can stimulate quality initiatives that aim to increase the overall
hospital score.

210
Poster 37

The Decussating Fibers of the Lumbar Thoracolumbar Fascia: A Landmark for Identifying the L5
Spinous Process?

Fernando Alonso, MD1; Doniel Drazin, MD, MA2, Tarush Rustagi, MD3, Rod Oskouian, MD4, Jens
Chapman, MD4, R. Tubbs, PhD5
1
Cedars-Sinai Medical Center, Seattle, Washington, 2Swedish Neuroscience Institute, Seattle,
WASHINGTON, 3, Syracuse, NY, 4, Seattle, WA, 5Seattle Science Foundation, Seattle, Washington

Background/Introduction: The thoracolumbar fascia has been well studied and is known to have
crisscrossing fibers. Based on surgical experience, we hypothesized that the decussating fibers of
this fascia might indicate a specific vertebral level. Therefore, the current anatomical study was
performed.

Materials/Methods: Twenty adult fresh frozen cadavers, ages 72-84 years old at death, were
placed in the prone position and the skin of the lumbar and upper sacrum was removed. Careful
attention was given to the thoracolumbar fascia and any fibers of it that grossly crossed the midline
to inderdigitate with its contralateral counterpart. Once such decussations were identified, a metal
wire was laid on them at their center and fluoroscopy performed to verify the vertebral level.

Results: Decussating fibers of the thoracolumbar fascia were found on all (95%) but one specimen.
Of these, the central part of the decussation on the midline corresponded to the spinous process of
L5 in 89% and the lower edge of the spinous process of L4 in the remaining two specimens (11%).
No specimen was found to have had previous surgery in the area dissected or congenital anomalies
of the spine such as a translational vertebra.

Discussion/Conclusion: Based on our cadaveric study, the decussating fibers of the thoracolumbar
fascia in the lumbar region can help predict most often the L5 spinous process and less often, the
spinous process of L4. This finding might be used as an adjunct to palpation and intraoperative
imaging during surgical exploration of the lower lumbar region.

211

212
Poster 38

Predictors of Major Complications Following Anterior Lumbar Fusion

Samantha Jacobs, BA1, William Ranson, BS2, Chierika Ukogu, BA2, Jun Kim, MD2, John Di Capua,
MHS, BS3, Sulaiman Somani, BS3, Robert Merrill, BS4, Samuel Cho, MD5
1
, New York, New York, 2, New York, NY, 3Icahn School of Medicine at Mount Sinai, New York,
New York, 4Mount Sinai Medical Center, New York, NY, 5, NY, NY

Background/Introduction: Introduction: Anterior lumbar fusion (ALF) procedures are indicated in
adult degenerative lumbar disorders and spondylolisthesis. This study seeks to identify the
predictors of major complications following ALF.

Materials/Methods: Methods: This was a retrospective analysis of American College of Surgeons
National Surgical Quality Improvement Program (ACS-NSQIP) database between 2011 and 2014 for
patients undergoing ALF. Patients with age <18 years, non-elective surgery, emergency surgery,
within 30 days of the principal operation were excluded from the study. Two cohorts were created
of patients who experienced 1 or more major complication and those that did not. Major
complications included wound, pulmonary, cardiac and renal complications, venous
thromboembolism, urinary tract infections, intra/postoperative transfusions, length of stays => 5
days, reoperation, unplanned readmission and mortality. Multivariate logistic regression models
were employed, adjusting for patient demographics, preoperative and intraoperative variables, to
identify predictive factors for major complications.

Results: Results: 3,138 ALF patients met the inclusion criteria for the study and 32.5% of patients
experienced one or more major complication. MVR (c-statistic=0.742) revealed total RVU (OR=
1.01, 1.01-1.02), male sex (OR=0.63, 0.53-0.74), white race (OR=0.61, 0.45-0.83, p-value=0.0017),
age≥ 65 years (OR=2.18, 1.80-2.64), independent functional status (OR=0.35, 0.19-0.65), cardiac
comorbidity (OR=1.41, 1.18-1.69), preoperative transfusion (OR=20.92, 2.36- 185.24), operation
time ≥ 4 hours (OR=3.12, 2.57-3.77) and ASA class ≥3 (OR=1.80, 1.50-2.14) were predictive factors
for major complications following ALF. P-values are <0.001 unless noted otherwise.

Discussion/Conclusion: Conclusion: There are many clinically relevant predictive factors for major
complications following elective ALF. Predictors for major complications include total RVU, sex,
race, age, dependent functional status, cardiac comorbidity, preoperative transfusion, operation
time and ASA class.

213

214
Poster 39

Correlation Between the Modic Changes and Facet Osteoarthritis in Lumbar Spine

Permsak Paholpak, MD1, EMIN DEDEOGULLARI, n/a2, Koji Tamai, MD1, Kaku Barkoh, MD1, Kittipong
Sessumpun, MD1, Jeffrey Wang, MD3; Zorica Buser, PhD4
1
, Los Angeles, CA, 2, n/a, n/a, 3Keck School of Medicine of USC, Los Angeles, CA, 4University of
Southern California, Keck School of Medicine, Los Angeles, CA

Background/Introduction: Modic changes (MCs) are detected on the MRI as bone marrow change
within the vertebral body and endplate. Most of the studies in lumbar spine focused on the
relationship between MCs and low back pain, but not with facet osteoarthritis. The aim of this
study was to identified the correlation between Modic changes and facet osteoarthritis in lumbar
spine using kinetic lumbar MRI images.

Materials/Methods: 425 patients who underwent kinetic lumbar MRI were reviewed. Total of
2,250 lumbar spinal segments in neutral position were evaluated for MCs, disc degeneration
grading, and facet osteoarthritis. The chi-square test, Mann-Whitney U test, Pearson’s correlation
and linear regression were used to test for statistical significant difference between parameters.

Results: Modic changes were detected in 105 patients (24.7%). One-hundred fifty-seven (7.4%)
lumbar segments from 2125 segments had MCs. Seventy-nine MCs were present at L5-S1, 44 at L4-
5, 23 at L3-4, 7 at L2-3, and 4 at L1-2. Type 2 MCS was the most common (66.24%, n = 104
segments) followed by type 1 (24.2%, n = 38 segments). The presence of MCs was significantly
correlated with advanced disc degeneration (grade 4-5, Odds ratio 6.29, 95% CI 4.48-8.83) and the
presence of facet osteoarthritis (Odds ratio 9.50, 95% CI 6.18-14.62). The facet osteoarthritis grade
was positively correlate with disc degeneration grade (r = 0.309, p-value < 0.001).

Discussion/Conclusion: Severe disc degeneration and the presence of facet osteoarthritis were
significantly linked to the presence of MCs. The severity of facet osteoarthritis was correlated with
the advanced disc degeneration grading but not with the presence of MCs. Presence of facet
ostearthritis is one of the important pathologies for evaluation of MCs.

215
Poster 40

Continued Inpatient Care After Posterior Lumbar Fusion Is Associated With Increased Post-
Discharge Complications: A Propensity-Adjusted Analysis

Andre Samuel, BBA1, Michael Fu, MD2, William Schairer, MD2, Peter Derman, MD2, Alexander
McLawhorn, MD2, Todd Albert, MD2
1
Yale School of Medicine, New Haven, CT, 2Hospital for Special Surgery, New York, NY

Background/Introduction: As bundled payment models become increasing prevalent in
orthopaedics, hospitals will be required to consider post-discharge care and clinical outcomes after
posterior lumbar fusion. There may be significant variations in post-discharge outcomes depending
on discharge destination, either to an inpatient facility (i.e. subacute or acute rehabilitation) or
home. The purpose of this study was to examine the 30-day post-discharge outcomes after lumbar
fusion with regards to patient discharge destination following their acute hospital stay.

Materials/Methods: The American College of Surgeons National Surgical Quality Improvement
Program database was queried for all 1- to 3-level primary posterior lumbar fusion cases from 2011
to 2014. Multivariable propensity-adjusted logistic regressions were performed to determine
associations between discharge destination and post-discharge complications, with adjusted odds
ratios (OR) and 95% confidence intervals (CI). To account for selection bias in discharge destination,
propensity scores were determined based on observable patient characteristics. For this study, the
propensity score was defined as the conditional probability of being discharged to an inpatient
facility based on demographics, obesity class, modified Charlson Comorbidity Index (CCI), baseline
functional status, American Society of Anesthesiologists (ASA) class, number of levels fused, and
the occurrence of any pre-discharge complications.

Results: A total of 18,652 posterior lumbar fusion cases were identified, 15,234 were discharged
home, and 3,418 were discharged to continued inpatient care. Multivariable propensity-adjusted
logistic regressions showed that being discharged to continued inpatient care was independently
associated with higher risk of any post-discharge complication (OR 1.24, 95% CI 1.06-1.46), deep
vein thrombosis and/or pulmonary embolism (OR 1.79, 95% CI 1.13-2.85), and urinary
complications (OR 1.79, 95% CI 1.27-2.51). Discharge destination was not significantly associated
with wound complications, other systemic complications, readmission, or death (Table 1).

Discussion/Conclusion: Discharge to continued inpatient care versus home after primary posterior
lumbar fusion is independently associated with higher odds of post-discharge complications. To
optimize clinical outcomes as well as cost savings in an era of bundled payments, clinicians and
hospitals should consider devoting resources toward facilitating home discharge after surgery
whenever possible.

216

217
FOUNDED 2008

ALPHABETICAL DISCLOSURE LISTING &
AUTHOR INDEX

Financial Disclosure

The names of authors presenting papers are printed in boldface in the program. All presenters,
secondary authors, and any other participant in the Annual Meeting have been asked to disclose if
he/she, or a member of his/her immediate family has a financial interest in and/or relationship with a
commercial company, supplier, or institution within the last twelve months. The LSRS has identified
the options to disclose as follows:

Financial Relationship Category Levels: A: Less than $5,000; B: $5,000-$20,000; C: $20,000-$100,000; D:
$100,001-$500,000; E: Greater than $500,000; Level N: No Financial Relationship; Level T: Travel
Reimbursement Only.
1. Speakers Bureau/Paid presentations

2. Paid or Unpaid employee or Consultant
3. Own stock or receive any royalties
4. Receive Research or Institutional Support as a PI
5. Receive Other financial/material support
6. Receive royalties, financial /material support from medical and/or associated publishers
7. Serve as either a paid or unpaid board or committee member for other entity outside LSRS?
(n) No Conflicts to Disclose
The LSRS does not view the existence of these disclosed interests or commitments as necessarily implying bias
or decreasing the value of the author’s participation in this activity.

We apologize for any oversight, deletion or misspelling. Any such occurrences were
unintentional. –LSRS Staff

218

Assigned ID's Last Name First Name Institution Disclosure
P03, RF12 Abiola Rasheed University of Utah (n.)
16 Ailon Tamir Vancouver Spine (n.)

Surgery Institute
P05 Ajiboye Remi UCLA Medical (n.)
Center
P05 Alas Haddy SUNY Downstate (n.)
College of Medicine
P28, P40 Albert Todd Hospital for Special 1.Depuy - B; 2.Depuy Synthes - B; 3.Depuy Synthes
Surgery Spine (royalties) - E, Biomet Zimer Spine (royalties) -
D, Facet-Link (stock options) - C, Gentis (stock options) -
C, Crosstree (stock options) - C; 5.Biomerix (stock
options) - A, Paradigm Spine (stock options) - D, In vivo
Therapeutics (stock options) - B, Spinicity (stock
options) - C, Invuity (stock options) - C; 6.Thieme
Medical Publishers - A; 7.United Healthcare (Medical
Advisory Board) - B, SRS (VP) (no financial relationship)
- N, CSRS (Past President) (no financial relationship) -
N, IMAST (Past Chair) (no financial relationship) -
N, AOA (Development Board) (no financial
relationship) - N;
P22 Alentado Vince (n.)
23 Alonso Andrea Case Western 2.Pfizer - D, Zymtronix, LLC - A; 3.Zymtronix, LLC -

Reserve University E; 7.Zymtronix, LLC - A;
School of Medicine
P37 Alonso Fernando Cedars-Sinai (n.)
Medical Center
P21, P36 Alvi Mohammed Ali Mayo Clinic (n.)
16 Ames Christopher University of 2.DePuy - B, Stryker - B, Medtronic - A; 3.Stryker -

California San D, Biomet Spine - C;
Fransisco
14, 22, P01, An Howard Rush University 2.Bioventus Inc. - A; 3.U&I Inc - D, Zimmer Spine Inc -
P34 Medical Center B, Spinal Kinetics - B, Medyssey Inc. - C; 4.Medyssey Inc.
- B;
RF24 Ariyawatkul Thanase Faculty of Medicine, (n.)
Siriraj Hospital,
Mahidol University
RF17, Arnold Paul (n.)
Moderator
Session 7,
Moderator
Sympoisum 3
219

24 Bae Hyun Cedars-Sinai Spine 1.Medtronic - A, DePuy J&J - C, RTI Surgical -
Center B; 2.NuVasive - C, Stryker - B, Zimmer - C, DePuy J&J -
C, Medtronic - B; 3.Nuvasive - C, Stryker - C, Biomet -
A; 4.Mainstay - B; 7.Cedars Sinai - A, St. John's
Providence - T;
P13 Baker Kevin 4.Arthrex (to institution) - C, Depuy-Synthes (to
Moderator institution) - C, Stryker Trauma (to institution) -
Session 4 D, Stryker Orthopedics (to institution) - C, DJO Global
(to institution) - C; 5.Zimmer (implants) - B;
19, 41, P15, Banagan Kelley 2.K2M - B;
P18, RF18
P39 Barkoh Kaku (n.)
07, 37 Barth Kathryn Northwestern (n.)

University
Department of
Orthopaedic
Surgery
RF15 Basques Bryce Rush University (n.)
Medical Center
P06 Belding Jonathan Metrohealth (n.)
Medical Center
15, RF09 Benzel Edward Cleveland Clinic (n.)
Foundation,
Neurological
Institute
RF23 Bernhard Jonathan Columbia 3.EpiBone, Inc. - A;
University
16, 17 Bess Shay 1.K2 medical - B; 3.K2 - A; 4.Depuy - D, Medtronic -
C, Stryker - B, K2 - D, Nuvasive - D;
36 Bhatt Surabhi Northwestern (n.)
University
04, 08, 26, 35, Bohl Daniel Rush University 5.CSRS - A, MAOA - A;
39 Medical Center
P31, RF09 Bomberger Thomas (n.)
09 Bono Olivia (n.)
RF01 Boody Barrett Northwestern (n.)

Memorial Hospital
RF06 Boone Ryan Oregon Health and (n.)
Science University
220

03, 08, 10, 12, Bovonratwet Patawut Yale School of (n.)
39, P32, P33, Medicine
RF10, RF20
02, 25 Boyajian Haroutioun (n.)
P03, P04, RF12 Brodke Darrel 2.Vallum - A; 5.Amedica - C, DePuy Synthes -

D, Medtronic - A; 7.AOSpine North America - B, CSRS -
T;
P23, P35 Bronheim Rachel (n.)
RF19 Brooks Daina 2.Globus Medical - C; 3.Globus Medical - A;
19, 41, P15, Brown Luke (n.)

P18, RF18
P39 Buser Zorica University of 2.Xenco Medical (consultancy) - B, AO Spine

Southern California, (consultancy)-past - B; 3.Gilead (stocks) - A;
Keck School of
Medicine
P21, P36 Bydon Mohamad (n.)
P20 Cao Na George Washington (n.)

University School of
Medicine
P17 Carreon Leah 4.SRS - A, OREF - A, Norton Healthcare - D; 5.Norton
Healthcare - A, University of Southern Denmark -
B, University of Louisville - A; 7.Scoliosis Research
Society - unpaid - A;
RF18 Cavanaugh Daniel (n.)
P01 Cazzulino Alejandro (n.)
P34 Cazzulino Alejandro University of 2.Bristol Meyers Squibb - D; 3.Bristol Meyers Squibb -
Pennsylvania D; 6.Columbia Suicide Severity Rating Scale - C;
34, 42, RF11 Cha Thomas MGH 2.Bio2 - B, GE Healthcare - B, Nuvasive - B, K2M -
B; 4.AO Spine - C, K2M - C, Depuy Synthes - C, North
American Spine Society - C, Gordon and Betty Moore
Foundation - C; 5.GE Healthcare - A, Bio2 - B, Nuvasive -
B;
P30, P37, Chapman Jens 3.Renovis - D; 7.AOSpine North America - B;
Modersator
Symposium 1
221

RF26 Chapman Todd Washington 1.Medicrea USA - A; 2.Medicrea USA - A; 6.Clinical
University School of Spine Journal - T; 7.North Carolina Spine Society - T;
Medicine
RF24 Chavasiri Cholavech Faculty of Medicine, (n.)
Siriraj Hospital,
Mahidol University
RF7 CHEN DENNIS University of (n.)
Virginia
Healthsystem
RF13 Chen Foster Montefiore Medical (n.)
Center, Orthopedic
Surgery
21, P14, P23, Cho Samuel 2.Zimmer Biomet - B, Globus Medical - B, Medtronic -
P26, P27, P35, B; 4.Zimmer Biomet - A; 7.Scoliosis Research Society -
P38, RF02, A, Cervical Spine Research Society - A, AOSpine North
RF29 America - A, North American Spine Society - A;
RF13 Cho Woojin Montefiore Medical (n.)

Center
P16, RF05, Chou Dean University of 2.Globus - B, Medtronic - B; 3.Globus - B;
RF25, California, San
Moderator Francisco
Sympoisum 2
07, 37 Chun Danielle Northwestern (n.)

University
Department of
Orthopaedic
Surgery
P34 Colman Matthew Rush University 1.MEDICREA - A; 2.MEDICREA - A, DEPUY SYNTHES
SPINE - A;
07, 37 Cook Ralph Northwestern (n.)
University
Department of
Orthopaedic
Surgery
05 Cowan Benjamin (n.)
03, 08, 10, 12, Cui Jonathan Yale School of 2.Merck & Co. - C;
RF20
222

Moderator Currier Bradford Mayo Clinic 2. Zimmer Spine, 3. DePuy Spine, 5. Stryker Spine,
Poster Session AOSNA Fellows
1
Moderator Daffner Scott West Virginia 2. Bioventus-B, 3. Pfizer-A, 3. Amgen-A, 4. Bioventus, 4.
Poster Session School of Medicine Pfizer, 4. Spinal Kinetics, 7. NASS-N, 7. CSRS-N
2
RF28, Dailey Andrew University of Utah 1.AO North America - A; 2.Medtronic - B; 3.Biomet -
Moderator C; 4.K2M - B;
Session 1
16, 38, P07 Daniels Alan Department of 2.Stryker - C, Orthofix - B, Globus - A, Depuy -
Orthopaedics, A; 4.Orthofix - A;
Division of Spine
Surgery- Adult
Spinal Deformity
Service, Warren
Alpert Medical
School of Brown
University
P13 Davidson Abby William Beaumont 2.Zimmer Biomet - C;
Hospital
P10 De la Garza- Rafael Johns Hopkins (n.)
Ramos Hospital
P39 DEDEOGULLARI EMIN (n.)
24 DePalma Michael Virginia iSpine 2.Medtronic - B, Mesoblast - A, Halyard - B, AnGes -

A; 4.Relievant - C, Mesoblast - C, Halyard - C, Vertiflexx
- C; 6.Demos - A; 7.Virginia Spine Research Institute, Inc
- T;
38, P07 DePasse J. Mason Department of (n.)
Orthopaedics,
Warren Alpert
Medical School of
Brown University
P40 Derman Peter Hospital for Special (n.)
Surgery
P34 Dewald Christopher Rush University 1.Kisco Corp - A, K2M - A; 2.Kisco Corp - B; 3.Medtronic
Medical Center - A; 7.NASS - T, Scoliosis Research Society - T;
P14, P23, P26, Di Capua John Icahn School of (n.)
P27, P35, P38, Medicine at Mount
RF02, RF29 Sinai
17 Diebo Bassel (n.)
223

RF04 Dirschl Douglas University of 2.Stryker Trauma - C, Bone Support - C;
Chicago Medical
Center
RF04 Divi Srikanth (n.)
Moderator Dodwad Shah-Nawaz The University of 1. Nuvasive - A, Stryker - A 2. Stryker - A,

Session 13 Texas Health
Science Center at
Houston
RF14 Dolitsky Robert Northwell Health (n.)
21, RF29 Dowdell James (n.)
P06 Drain Joseph (n.)
29, P24, P37 Drazin Doniel Swedish (n.)

Neuroscience
Institute
38, P07 Durand Wesley Brown University, (n.)
Warren Alpert
Medical School
P16, RF05, Eastlack Robert Scripps Clinic 1.Eli Lilly - A; 3.Spine Innovations - D, Nuvasive -
RF25 D, Alphatec - C, Invuity - A, Carevature - A; 4.Nuvasive -
A; 5.Alphatec - B, Aesculap - A, Don Joy - A, Nuvasive -
C, Stryker - B; 6.Globus - A; 7.Scoliosis Research Society
- A, Society of Lateral Access Surgery - A;
31, 33, RF21 Elder Benjamin Johns Hopkins (n.)
Medicine
RF04 Eleswarapu Ananth University of (n.)
Chicago Medical
Center
30 Elkhayat Adam (n.)
38, P07 Eltorai Adam Warren Alpert (n.)

Medical School of
Brown University
17 Errico Thomas 1.K2M - B; 2.K2M - B; 3.Fastenetix - D; 4.Pfizer -
B, Paradigm Spine - B, Medtronic - B; 5.K2M (for
trips/travel) - B;
P08 Falk David George Washington 4.Shire - C; 5.Adare and Banner - A;
University
Department of
Orthopaedic
Surgery
224

RF27 Faundez Antonio 3. Division of (n.)
Orthopaedic
Surgery, Geneva
University
Hospitals, Meyrin,
Switzerland
P03, RF12 Ferrel Jason University of Utah (n.)
P16 Fessler Richard Rush University 3.Medtronic - B, DePuy - B, Stryker - B; 7.Lawrence

Medical Center University - A;
P30 Fisahn Christian Swedish (n.)
Neuroscience
Institute, Swedish
Medical Center
01, 18, 20, 27, Fischer Charla Columbia University 1.K2M - A; 2.Stryker - A, Invuity - A, Medicrea - A;
32, P29, RF16 Department of
Orthopaedic
Surgery
24, P13, Fischgrund Jeffrey William Beaumont 2.stryker - D, Relievant - C; 3.Stryker - C; 6.JAAOS -
Moderator Hospital C; 7.CSRS - A;
Session 10
09 Francis Anna-Marie (n.)
P10 Frank Steven 1.Medtronic - A, Haemonetics - A, Zimmer-Biomet -

A; 7.American Assn. of Blood Banks - T, Am. Society of
Anesthesiologists - T;
24 Franke Jorg Klinik fur 1.medtronic - B, Zimmer - B, medacta - B, Paradigm -
Orthopaedie C. A; 2.medtronic - B, Medacta - A, expanding othopedics
Wirbelsaulen-und - A; 3.medacta - A, ohst - A; 4.relievant - C, baxter -
Kinderorthopadie C, zimmer - B, medtronic - C; 7.medtronic - A;
07 Freshman Ryan Northwestern (n.)

University
Department of
Orthopaedic
Surgery
RF19 Frisch Richard 1.Globus - C; 2.Globus - C; 3.Globus - A; 4.Globus -
C; 6.Spine Journal - A;
P28, P40 Fu Michael Hospital for Special (n.)
Surgery
12 Gala Raj Yale School of (n.)
Medicine
30 Gayoso Matthew (n.)
10, RF10 Geddes Benjamin Yale School of (n.)

Medicine
225

P13 Geisinger Jonathon Beaumont Health (n.)
19, 41, P15, Gelb Daniel 1.AOSpine North America - A, DePuy Synthes Spine -
P18, RF18 A; 2.DuPuy Synthes Spine - C; 3.DePuy Synthes Spine -
B, Globus Medical - A;
P11 George Andrew (n.)
09, 17 Gerling Michael Hospital for Special (n.)

Surgery
RF27, Ghanayem Alexander 1. Department of 6. CSRS, OmeGa medical grants, AAOS, AOA, level=n
Moderator Orthopaedic
Poster Session Surgery &
3 Rehabilitation,
Loyola University
Medical Center
P17 Glassman Steven 3.Medtronic - E;
P01 Goldberg Edward
Moderator Goldstein Ira Rutgers The State 2. Zimmer Biomet Spine-C, 3. Alphatec Spine-C, 6. The
Session 4 Univeristy of New Spine Journal-A, 6. eMedicine-A, 6. WebMed Central-A,
Jersey 7. NASS-A
P10, P31 Goodwin C. Rory Johns Hopkins 4.The Johns Hopkins Neurosurgery Pain Research
Hospital Institute - C, Burroughs Wellcome Fund - C, UNCF-
Merck Science Initiative - C;
34 Gordon Tricia
40, P22 Gould Heath
Moderator Graziano Gregory Henry Ford Health 7. AOA Program Committee - N

Session 9 Systems
03, 08, 10, 12, Grauer Jonathan Yale School of 2.Bioventus - B, Medtronic - A, Stryker - C; 5.Pfizer -
39, P32, P33, Medicine B, Spinal Kinetics - B, Orthofix - B; 7.North American
RF10, RF20, Spine Society - A;
Course Chair
RF28 Guan Jian University of Utah
30 Gupta Munish 1.Orthofix - B; 2.DePuy - B, Orthofix - B; 3.Proctor &

Gamble - C, Pfizer - B, Johnson & Johnson - C; 4.DePuy,
Harms Study Group - B; 6.Jaycee Publishers - A; 7.SRS,
Board of DIrectors upaid, ended 12/31/15 - T;
21 Guzman Javier (n.)
226

P36 Habermann Elizabeth Mayo Clinic (n.)
Moderator Hah Raymond Keck School of (n.)

Session 9 Medicine of USC
40, P22 Haines Colin (n.)
RF06 Haj Valentina Oregon Health and (n.)

Science University
Moderator Hamilton D. Kojo University of 4. Pfizer - A
Session 6 Pittsburgh School of
Medicine
P36 Hanson Kristine Mayo Clinic (n.)
14, 22, 32, Hardy Nathan (n.)

RF16
16, P24 Hart Robert Oregon Health and 1.DepuySynthes - B, Globus - A; 2.DepuySynthes -
Science University C, Globus - A; 3.Seaspine - C, DepuySynthes - A; 4.ISSGF
- C; 7.ISSG - A, ISSLS - A, CSRS - A;
Moderator Harrop James Thomas Jefferson
1. Johnson and Johnson (Depuy Ethicon)-B, 1. Globus-B,
Poster Session University
1. Tejin-A, 1. Bioventus-A, 1. Asterias-A, 7. AO Spine
3
North America and International, 7. CSRS, 7. CNS, 7.
PNS, 7. NASS, AANS, and SRS committees
RF01 Hashmi Sohaib Northwestern (n.)
University
P19, RF20, RF7 Hassanzadeh Hamid 1.NuVasive - A; 4.OrthoFix - C, Pfizer - D;
RF27 Havey Robert Orthopedic (n.)

Biomechanics Lab
Edward Hines Jr. VA
Hospital
Moderator Heary Robert F. Rutgers The State
3. Depuy Spine-D, Zimmer Spine-B, 6.
Session 16 Univeristy of New
Thieme Medical Publishers-A, 7. CSRST,
Jersey
AANS-T
21 Hecht Andrew 2.Zimmer - A, Stryker Spine - A, Medtronic -
A; 3.Johnson and Johnsons - A, Zimmer - A; 6.American
Journal of Orthopedics - A, Global Spine Journal -
A, Journal of Spinal Disorders and Techniques -
A, Orthopedics Today - A, Orthopedic Knowledge
Online Journal - A; 7.AAOS Musculoskeletal Transplant
Foundation - A;
P20 Heyer Jessica George Washington (n.)
University Hospital
227

04, 26, 28, 35, Hijji Fady (n.)
RF03, RF15
RF06 Hiratzka Jayme Oregon Health & 2.Depuy Synthes Spine - B, Amedica - A;
Science University
31, 33, RF21 Holmes Christina Johns Hopkins (n.)
Medicine
09, 17 Horn Samantha (n.)
RF22 Hoshide Reid University of (n.)

California, San
Diego
P08 Hoy Michael George Washington (n.)
University
Department of
Orthopaedic
Surgery
P11, Hsu Erin Northwestern 2.Bioventus - B, Stryker - C, Medtronic - B, Ceramtec -
Moderator University B, Relievant - B; 5.Medtronic - C; 6.Stryker -
Session 12 Department of C; 7.Orthopaedic Research Society - A;
Orthopaedic
Surgery
07, 36, 37, Hsu Wellington Northwestern 1.Stryker - D, Bioventus - B, Medtronic - B, Xtant -
P11, P25, Memorial Hospital B, Allosource - B; 3.Stryker - D; 4.Medtronic - C;
RF01, Speaker
Symposium 2,
moderator
session 11
15, 40 Hu Emily Case Western (n.)

Reserve University
School of Medicine
P14, RF29 Hussain Awais (n.)
02, 25 Idowu Olumuyiwa (n.)
17, P16, RF05, International 4.DePuy Synthes Spine - D, K2M - D, NuVasive -

RF25 Spine Study D, Stryker - D, Medtronics - D; 5.Innovasis - D;
Group
31, 33, RF21 Ishida Wataru Johns Hopkins (n.)
Medicine
228

P28 Iyer Sravisht Hospital for Special 4.Cervical Spine Research Society - Grant Support to
Surgery Institution - B; 7.Journal of Young Investigators -
Unpaid Board Member - A;
P14, P26, P27, Jacobs Samantha (n.)
P35, P38,
RF02, RF29
P19, RF20 Jain Amit (n.)
13, P02 Jain Nikhil Ohio State (n.)

University
09, 17 Jalai Cyrus (n.)
RF11 Janssen Stein MGH (n.)
19, P17 Jazini Ehsan (n.)
05, 34, Jenis Louis Massachusetts 2.Stryker - A, NuVasive - A; 3.Stryker - C;

Moderator RF General Hospital
Session 8
P25 Jenkins Tyler Northwestern (n.)

University -
Feinberg School of
Medicine
P30 Jeyamohan Shiveindra Swedish (n.)
Neuroscience
Institute, Swedish
Medical Center
30 Jing Liufang Washington (n.)
University in St.
Louis
38, P07 Johnson Joseph Brown University (n.)
P13 Jones Chad Beaumont Health (n.)
RF19 Joshua Gita Globus Medical 2.Globus Medical Inc - C; 3.Stock Option - B; 5.Globus
Medical Inc - A;
41, P18 Juaregui Julio University of (n.)
Maryland Medical
Center
P23 Kaji Deepak (n.)
P11 Katchko Karina (n.)
229

RF20 Kebaish Khaled Johns Hopkins 2.Depuy Synthes - C, K2M - B, Orthofix - B; 6.Depuy
University School of Synthes - C;
Medicine
P06 Kelly Michael Metrohealth (n.)
Medical Center
P21, P36 Kerezoudis Panagiotis Mayo Clinic (n.)
19 Khalsa Kevin University of (n.)

Maryland,
Baltimore
42 Khan Kamran Harvard Medical (n.)
School/Massachuse
tts General
Hospital
13, P02 Khan Safdar 1.DePuy Synthes - A; 2.Prosydian - A, DePuy Synthes -
A; 6.Clinical Spine Surgery (JSDT) - editor - A; 7.AAOS
Biologic Implants Committee - A, NASS Biologics
Committee - A;
RF27 Khayatzadeh Saeed Orthopedic (n.)
Biomechanics Lab,
Hines VA Hospital
RF20 Kim David New England 1.Convatec - A; 2.Bioventus - C, Intrinsic Therapeutics -
Baptist Hospital C;
21, P14, P23, Kim Jun (n.)
P26, P27, P35,
P38, RF02,
RF29
41 Koenig Scott University of (n.)

Maryland Medical
Center
19, 41, P15, Koh Eugene 2.Biomet - B; 4.NIH RO1 - B;
P18, RF18
P24 Kong Christopher Oregon Health & (n.)

Science University
Moderator Koreckij Theodore University of 3. Nuvasive - A
Session 5 Missouri - Kansas
City Medical Center
P23 Kothari Parth Icahn School of (n.)
Medicine at Mount
Sinai
04, 26, 28, 35 Kudaravalli Krishna (n.)
230

06, P09 Kurra Swamy (n.)
RF14 Kyhos Justin Northwestern (n.)

University
16, 17 Lafage Virginie Hospital for Special 1.DePuy Spine Synthesis - A, Medicrea - A, NuVasive -
Surgery A, Nemaris INC - T; 2.NuVasive - A; 3.Nemaris INC -
B; 4.SRS - B, NIH - B, DePuy Spine (trough ISSGF) - E;
01, 14, 18, 20, Laratta Joseph (n.)
22, 27, 32,
P01, P29,
RF16, RF23
06, P09, Lavelle William SUNY Upstate 4.DePuy - A;

Moderator Medical University
Sessiom 7
P03, P04, RF12 Lawrence Brandon (n.)
RF27 Le Huec Jean-Charles Orthopaedic (n.)

Surgery, Bordeaux
University Hospital
02, 25, RF04, Lee Michael University of 2.Stryker Spine - C, Depuy Synthes - C;
Moderator Chicago Medical
Session 15 Center
P23, RF29 Lee Nathan Icahn School of (n.)

Medicine at Mount
Sinai
P11 Lee Sohyun (n.)
01, 14, 18, 20, Lehman Ronald 1.Medtronic - C, Stryker - B, DePuy Synthes Spine -
22, 27, 32, B; 2.Medtronic - C; 4.PRORP (Dept of Defense Peer
P01, P29, P34, Reviewed Orthopaedic Research Program) -
RF16, RF23 E; 6.Orthopedic Knowledge Update Spine 5 Section
Editor (unpaid) - A; 7.SRS: IMAST Chair (unpaid) -
A, CSRS: CME Chair (unpaid) - A, NASS: PCP Chair
(unpaid) - A;
30 Leimer Elizabeth (n.)
231

01, 14, 18, 20, Lenke Lawrence 2.Medtronic - E; 3.Medtronic - E, Quality Medical
22, 32, P01, Publishing - A; 4.Setting Scoliosis Straight Foundation -
RF16, RF23 T, AOSpine - T, Scoliosis Research Society - T, Fox Family
Foundation - T, EOS Imaging - T; 6.Medtronic -
E, Quality Medical Publishing - A; 7.Broadwater -
T, Medtronic - E, K2M - T, Depuy Synthese - T, AOSpine
- T;
42 Li Guoan Massachusetts (n.)
General Hospital
38, P07 Li Neill Department of (n.)
Orthopaedics,
Warren Alpert
Medical School of
Brown University
RF06 Lieberman Elizabeth Oregon Health and (n.)
Science University
RF22 Lin Gloria 2.SpineOvations, Inc. - B; 3.Essentialis, Inc. - B;
01, RF16 Lin James Columbia University (n.)

Medical Center
Moderator Lim Chi Orthopeadic 2. Implanet - A, Corelink - T;
Session 10 Associates
17 Line Breton 5.International Spine Study Group - C;
P06 Liu James Metrohealth (n.)

medical center
RF21 Lo Sheng-Fu Johns Hopkins (n.)
Medicine
31, 33, RF21 Locke John (n.)
14, 22, 27, 32, Lombardi Joseph (n.)

P29, RF16
RF03 Long William Rush University (n.)

Medical Center
RF15 Louie Philip Rush University (n.)
Medical Center
29 Loukas Marios 6.Elsevier - B, Wiley - A;
P28 Lovecchio Francis Hospital for Special (n.)

Surgery
P31, RF09 Lubelski Daniel Johns Hopkins (n.)
Hospital
232

19, 41, P15, Ludwig Steven 1.Depuy-synthes - B; 2.DePuy Synthes Spine - C, K2M -
P18, RF18 C; 3.DePuy Synthes - D, ISD - E, ASIP - B; 4.Pacira - C, AO
spine north america - C; 7.Globus Medical - A;
39 Lukasiewicz Adam Yale School of (n.)
Medicine
RF24 Luksanapruska Panya Department of (n.)
Orthopedic Surgery,
Faculty of Medicine
Siriraj Hospital
RF19 Luna Ingrid Globus Medical 2.Globus Medical employee - C;
P13 Maerz Tristan (n.)
P34 Makhni Melvin Columbia (n.)

University
RF22 Manesis Nick 2.Spineovations - C; 3.Spineovations - C;
36, Moderator Maniar Hemil Geisinger Health (n.)

Session 15 Systems
RF06 Marshall Lynn Oregon Health and (n.)

Science University
P25, RF01 Maslak Joseph Northwestern (n.)
University -
Feinberg School of
Medicine
04, 26, 35, Massel Dustin Rush University (n.)
RF03 Medical Center
04, 26, 35, Mayo Benjamin Rush University (n.)

RF03 Medical Center
RF01 McCarthy Michael (n.)
RF26 McConda David OrthoCarolina Spine (n.)

Center
P40 McLawhorn Alexander Hospital for Special (n.)
Surgery
03, 08, 10, 12, McLynn Ryan Yale School of (n.)
RF20
P09 Meath Benjamin SUNY Upstate (n.)

Medical University
233

15 Mehdi Syed Case Western (n.)
Reserve University
School of Medicine
Moderator Mehta Ankit University of Illinois (n.)
Session 16, Chicago
Speaker
Symposium 2
P12 Mercer Brian (n.)
21, P38, RF29 Merrill Robert Mount Sinai (n.)

Medical Center
RF8 Mesfin Addisu University of 4.Globus - C; 7.AAOS - A, CSRS - A, SRS - A, J Robert

Rochester Gladden Society - A;
24 Meyer Bernhard Depart of 1.Medtronic - A; 2.Ulrich Medical - B, Medtronic -
Neurosurgery A; 3.Spineart - A; 4.Ulrich Medical - C, Medtronic -
Technical Univ. of C, Relievant - B; 5.Nexstim Oy - T, Spineart - T; 6.Acta
Munich Neurochir - A, Neurosurgery - A, Eur Spine J -
A; 7.Eurospine Society - T, German Spine Society -
T, EANS - T, IGASS - T;
16 Miller Emily The Johns Hopkins (n.)
Hospital
Departments of
Orthopaedic
Surgery and
Neurosurgery,
RF03 Modi Krishna Rush University (n.)
Medical Center
P30 Moisi Marc Swedish (n.)
Neuroscience
Institute, Swedish
Medical Center
RF04 Mok James University of 1.Stryker - A; 2.Stryker - A;
Chicago Medical
Center
09 Moon John (n.)
40, Moderator Moore Don Cleveland Clinic (n.)

Session 2
P06, Moore Timothy Metrohealth 7.CSRS - T, AAOS - T, OTA - T;

Moderator Medical Center
Session 14
234

02 Mosenthal William (n.)
15, 23, 40, Mroz Thomas Cleveland Clinic 2.Stryker Spine - C, RTI Surgical - B; 3.PearlDiver Inc - A;
P22, RF09 Foundation,
Neurological
Institute
P29 Mueller John (n.)
P16, RF05, Mummaneni Praveen 1.AO Spine - A; 2.Depuy Synthes - B; 3.Depuy Synthes -
RF25 D, Spinicity/ISD - C; 6.Thieme publishing - A, Springer
publishing - A; 7.Aans/cns Spine Section - A, SRS - A;
P16, RF05, Mundis Gregory San Diego Spine 1.Nuvasive - B, Misonix - A, Medicrea - A; 2.Nuvasive -
RF25 Foundation C, K2M - A, Misonix - A, Medicrea - A, Ellipse -
A; 6.Nuvasive - B, K2M - A;
04, 26, 28, 35, Narain Ankur (n.)
RF03, RF15
P04 Neese Ashley (n.)
RF10 Nelson Stephen Yale University (n.)

School of Medicine
RF25 Nguyen Stacie San Diego Spine (n.)
Foundation
P30 Norvell Daniel Spectrum Research, (n.)
Inc.
RF7 NOURBAKHSH ALI (n.)
P16, RF05, Nunley Pierce Spine Institute of 1.K2M - B, LDR Spine - B; 2.Vertiflex - C; 3.Osprey
RF25 Louisiana Biomedical - B, LDR Spine - C, K2M - B; 4.Pfizer, Inc -
B, Seikagaku Corporation - B, LDR Spine - B; 5.Pfizer -
B; 6.Reviewer for The Spine Journal - A; 7.American
Board of Spine Surgery (ABSS) - A;
P27 Nwachukwu Chuma (n.)
P22 O'Donnell Jeffrey (n.)
P08, RF14, O’Brien Joseph 2.Globus - D, RTI - C, Relivant - B, Depuy - B; 3.K2m -

RF19 C, RTI - C, 4 Web - D; 4.RTI - D, Globus - C;
11, RF26 Odum Susan OrthoCarolina 7.American Joint Replacement Registry - A;

Research Institute
235

03, 08, 10, 12, Ondeck Nathaniel (n.)
39, P32, P33,
RF10, RF20
Moderator Orndorff Douglas Spine Colorado 2.Nuvasive - B, Seaspine - C, Stryker - A; 3.Seaspine -

Session 14 A; 4.Globus Medical - B, Seaspine - B, Vertiflex -
B, Nuvasive - C; 6.Seaspine - A;
29, P30, P37 Oskouian Rod (n.)
03, P32 Ottesen Taylor Yale University (n.)

School of Medicine
21 Overley Samuel (n.)
P30 Page Jeni Swedish (n.)

Neuroscience
Institute, Swedish
Medical Center
P39 Paholpak Permsak (n.)
P13 Park Daniel 2.K2m - B, Stryker - B;
09, 17 Passias Peter Hospital for Special 1.Medicrea - A; 2.Medicrea - A, Spinewave - A; 4.CSRS -
Surgery C;
07, 36, 37, Patel Alpesh Northwestern 2.Zimmer Biomet - B, Depuy - B, Relievant - B, Pacira -
P25, RF01, University A; 3.Vital5 - A, Cytonics - A, Nocimed - A, Amedica -
Moderator A; 6.Amedica - B, Biomet - A; 7.CSRS - A, JAAOS - B;
Session 5
Moderator Patel Tushar OrthoVirginia 2. Stryker - a, 3. DePuy Synthes - D,

Session 11
P25 Patoli Daneel (n.)
RF27 Patwardhan Avinash 1. Department of 2.spinal kinetics - T; 3.spinal kinetics - A, ortho

Orthopaedic kinematics - A; 4.spinal kinetics - A; 7.scientific advisory
Surgery & board, spinal kinematics - A;
Rehabilitation,
Loyola University
Medical Center,
Maywood, Illinois,
USA
RF11 Paulino Pereira Nuno
123 Perez-Cruet Mick 3.Thompson MIS - A, MI4Spine LLC - A; 6.CRC Press -

A, Quality Medical Publishing Inc - A; 7.Michigan Head
and Spine Institute - B;
236

RF23 Petridis Petros Columbia
University
13, 14, 22, Phillips Frank 2.Nuvasive - C; 3.Nuvasive - E, Stryker - D, DePuy -
P01, P02, P34, A, Medtronic - A, SI Bone, Spinal Kinetics, Vertera, -
RF15 A; 6.Thieme - A, Int Spine Journal - A; 7.ISASS - A, SMISS
- A, SOLAS - A, Theracell - A, Vital 5 - A;
RF24 Pichaisak Witchate Faculty of Medicine,

Siriraj Hospital,
Mahidol University
Speaker Polly David
Symposium 3
University of
Minnesota 7. Scoliosis Research Society-T
09, 17 Poorman Gregory
P05 Pourtaheri Sina University of

California, Los
Angeles
RF20 Praveen Kadimcherla
P03 Presson Angela
14, 22, P01, Pugely Andrew 6.CORR Associate Editor - A; 7.AAOS - T, NASS - T;
RF16
P10, P31 Purvis Taylor Johns Hopkins

School of Medicine
P19, RF20 Puvanesarajah Varun
P15 Pyun Joseph University of

Maryland Medical
Center
P19, RF20, RF7 QURESHI RABIA
21 Qureshi Sheeraz Mount Sinai 1.Stryker - C, Medtronic - A, Pacira - B; 6.Zimmer -

Medical Center A; 7.Csrs - A, Aaos - A, Nass - A;
RF06 Radoslovich Stephanie Oregon Health and
Science University
25 Ramos Edwin
P14, P26, P27, Ranson William

P35, P38, RF02
237

P20 Rao Raj George Washington 7.Chair, US FDA Orthopaedic Devices Panel -
University A, American Orthopaedic Association - T, The Spine
Journal - T;
Speaker Rechtine Glenn 6. Journal of Spinal Cord Medicine - N
Symposium 3
16 Reid Daniel Brown

University/Rhode
Island Hospital
24 Rhyne Alfred OrthoCarolina 2.Relievant Medsystems - B;
32 Riew K 1.Medtronic - B, Zeiss - A, Biomet - B; 3.Osprey -

A, Expanding Orthopedics - A, Spineology - B, Spinal
Kinetics - C, Nexgen Spine - B; 6.Medtronic Sofamor
Danek (G, Posterior Cervical Instrumentation) -
E, Zimmer-Biomet (F, Royalty for C-Tek & Maxan
Anterior Cervical Plate) - D; 7.AOSpine International -
C, Cervical Spine Research Society - T, Korean Spine
Society - T, North American Spine Society - T, Scoliosis
Research Society - T;
P13 Roberts Richard Beaumont Health
RF23 Robinson Samuel Columbia

University
32 Romanov Alexander
P37 Rustagi Tarush
14, 22, 32, Saifi Comron Midwest 2.Vertera - A; 3.Novartis - A, Gilead - A;

P01, P34, Orthopedics at
RF16, RF23 Rush
P13 Salisbury Meagan Beaumont Health
P11 Samra Nehal
08, P40 Samuel Andre Yale School of

Medicine
29 Sanders Filipe
RF22 Santiago- David

Dieppa
18, 20 Sarpong Nana Columbia College of
Physician's and
Surgeons
238

24 Sasso Rick 3.Medtronic - E; 4.Medtronic - C, Cerapedics -
C; 6.Journal spinal disorders - A; 7.Cervical spine
research society - A;
15, 23, 36, Savage Jason The Cleveland 1.Stryker Spine - B; 2.Stryker Spine - B;
P22, Clinic
Moderator
Session 12,
Speaker
Symposium 2
P40 Schairer William Hospital for Special

Surgery
07, 37 Schallmo Michael Northwestern
University
Department of
Orthopaedic
Surgery
123 Scheer Justin University of
California San
Diego
RF28 Schmidt Meic University of Utah
P11 Schneider Andrew
34, RF11 Schwab Joseph MGH
Speaker Schroeder Gregory 4. Medtronic - B, 6. Clinical Spine Surgery - N, 7.

Sympoisum 1 AOSpine - T
P10, P31, Sciubba Daniel Johns Hopkins 2.Medtronic - B, Depuy-Synthes - B, Globus - B, Stryker
Course Chair Hospital - B;
RF26 Segebarth P. Brad OrthoCarolina 2.Nuvasive - B, DePuy/Synthes Spine - A; 4.Medtronic

Sofamor Danek USA - C, Nuvasive - B; 7.AO Spine North
America Faculty - A;
Moderator Sembrano Jonathan University of
4. NuVasive-T, 5. NuVasive-A, 7.
Session 3 Minnesota
Philippine Minnesotan Medical
Association-T
P39 Sessumpun Kittipong
30 Setton Lori Washington 2.Cytex - C; 3.PhaseBio Pharmaceuticals - A; 6.Elsevier -

University in St. C; 7.Orthopaedic Research Society - T, Biomedical
Louis Engineering Society - T, AIMBE - T;
239

16, P16, RF05, Shaffrey Christopher University of 1.K2M - B, Stryker - B, Nuvasive - B; 2.Biomet -
Speaker Virginia Medical A, Nuvasive - B, Medtonic - B; 3.Nuvasive -
Symposium 1 Center D, Medtronic - D, Biomet - D; 7.ABNS - T, AANS -
T, CSRS - T;
40 Shao Jianning
123, 15, P05 Sharma Akshay Case Western

Reserve University,
School of Medicine
41, P18 Shasti Mark University of
Maryland Medical
Center
P19, RF20, RF7 Shen Francis 2.DePuy Synthes Spine - B, Medtronic - B, Axsome
Therapeutic - A; 3.Globus Medical - C; 6.Elsevier -
A, The Spine Journal - T, SPINE - T, European Spine
Journal - T, MTF - A; 7.CSRS - T, NASS - T;
P21 Shepherd Daniel Mayo Clinic,
Rochester, MN
02, 25, RF04 Shi Lewis
01, 14, 18, 20, Shillingford Jamal

22, 27, 32,
P29, RF16,
RF23
P19, RF20, RF7 Shimer Adam 1.Stryker - B; 6.Nuvasive - B;
03, 10, 12, 39, Shultz Blake Yale School of

P32, P33 Medicine
07, 37, P11 Singh Gurmit
04, 26, 28, 35, Singh Kern Rush University 2.Depuy - A, Zimmer - A, Stryker - B, Globus - A; 3.Avaz
RF03, RF15 Medical Center Surgical - B; 6.Stryker - B, Zimmer - B, RTI Surgical -
B, Thieme - A, Jaypee Publishing - A; 7.Vital 5 LLC -
A, TruVue Surgical - A, Avaz Surgical - A, Bijali - A;
07, 37 Singh Sameer Northwestern
University
Department of
Orthopaedic
Surgery
RF7 Singla Anuj
240

RF14 Smith Evan George Washington
University
Speaker Smith Harvey
2. DePuy-A, Globus-A, 7. Association
Symposium 3
Collaborative Spine Research-T,
Nuvasive-T
16 Smith Justin University of 1.Zimmer Biomet - B, Nuvasive - B, K2M - B; 2.Zimmer
Virginia Biomet - D, Nuvasive - A, Cerapedics - B; 3.Zimmer
Biomet - B; 4.DePuy Synthes - B;
21, P14, P23, Somani Sulaiman Icahn School of
P26, P27, P35, Medicine at Mount
P38, RF02 Sinai
11, Moderator Spector Leo OrthoCarolina 1.Stryker Spine - B; 2.Stryker Spine - B;

Poster Session
1
P03, P04, RF12 Spiker W. Ryan 2.NEXXT - A, NEXUS Orthopaedics - A;
P03, RF12 Spina Nicholas University of Utah
P04 Squires Mathieu University of Utah

School of Medicine
15, 23, 40, Steinmetz Michael Cleveland Clinic, 1.Globus - A, Stryker spine - A; 2.Intellirod - A; 3.Biomet
P06, RF09 Department of - B; 7.x - T, Neuropoint alliance - T, Council of State
Neurosurgery Neurosurgical Societies - T;
RF04 Stout Christopher ATI Physical 6.Wiley - B, Praeger/ABC-CILO - A; 7.Kiio Technologies -
Therapy A;
P08 Studdard Natalie The Orthopaedic
Center
P06 Sultan Assem Cleveland Clinic
06, P09 Sun Mike
06, P09 Tallarico Richard 1.Stryker Spine - C; 2.Stryker Spine - C;
P39 Tamai Koji
01 Tan Lee Columbia University

Medical Center
241

15, 23, P31, Tanenbaum Joseph Case Western
RF09 Reserve University
School of Medicine
P12 Tannoury Chadi Boston University
Medical Center
P12 Tannoury Tony Boston University 2.Depuy Johnson and Johnson - C; 3.Depuy Johnson
Medical Center and Johnson - C;
RF13 Tarpada Sandip Albert Einstein 1.NONE - A; 3.NONE - A; 4.NONE - A; 5.NONE -
College of Medicine A; 6.NONE - A; 7.NONE - A;
RF21 Taylor Maritza
RF22 Taylor Natalie
RF22 Taylor William University of 2.Spinovations - A; 3.Nuvasive - C; 5.Depuy - B; 7.Smiss

California, San - A;
Diego
RF11 Theyskens Nina
P24 Treggiari Miriam
Moderator Tribus Clifford University of 1. Stryker, level-B; 2. Stryker, Zimmer, Spineology,

Session 6, Wisconsin level-C; 3. Stryker, Zimmer, Spineology, level-D; 4.
Moderator Medtronic, level-C; 6. JSDT, Spine, level-A; 7. CSRS, SRS,
Symposium 3 level - n
Moderator Tromanhauser Scott

Session RF
7. NASS-Committee Member- N, 7. New England
Session 8
Baptist Hospital- Board Member-N
24 Truumees Eeric Seton Spine and 3.Stryker - B; 4.Pfizer - B, Relievant - B; 6.AAOS -
Scoliosis Center B, NASS - B; 7.NASS - T, AAOS - T;
29, P30, P37 Tubbs R. Seattle Science
Foundation
23 Tye Erik
P36 Ubl Daniel Mayo Clinic
P14, P26, P27, Ukogu Chierika

P35, P38,
RF02, RF29
15 Vallabh Sagar Case Western

Reserve University
School of Medicine
242

RF24 Vamvanij Visit Faculty of Medicine,
Siriraj Hospital,
Mahidol University
11 Van Doren Bryce OrthoCarolina 2.ARO Medical - A;
Research Institute
RF02 Vargas Luilly Icahn School of
Medicine at Mount
Sinai
RF29 Vig Khushdeep Mount Sinai
Medical Center
13 Virk Sohrab
29 Voin Vlad
P08 Vora Darshan George Washington

University
Department of
Orthopaedic
Surgery
RF27 Voronov Leonard 1. Department of
Orthopaedic
Surgery &
Rehabilitation,
Loyola University
Medical Center
RF23 Vunjak- Gordana Columbia
Novakovic University
RF22 Wali Arvin University of
California, San
Diego -
Neurosurgery
P39 Wang Jeffrey Keck School of 3.biomet - D, amedica - B, aesculap, synthes -
Medicine of USC B, seaspine - C, Bone Biologics, Corespine, Expanding
Ortho, Pearldiver, Flexuspine, Axis, Fziomed, Benvenue,
Promethean, Nexgen, Electrocore, Surgitech
(investments or options, no money received) -
A; 6.global spine journal - T; 7.CSRS - T, AOSpine -
C, NASS - T, NASF - T;
08, RF20 Webb Matthew Yale School of
Medicine
27, RF23 Weidenbaum Mark Columbia University 1.Stryker Spine - A; 7.Spinecraft - B;
Medical Center
07, 37 Weiner Joseph Northwestern
University
Department of
Orthopaedic
Surgery
243

19, P15, RF18 Weir Tristan
RF24 Wilartratsami Sirichai Faculty of Medicine,

Siriraj Hospital,
Mahidol University
Moderator Williams Seth University of
Session 13 Wisconsin
P33 Wilson Alexander
Speaker Wilson Jefferson 2. Stryker - c; 6. Clinical Spine Surgery Journal - A

Sympoisum 1
31, 33, P10, Witham Timothy Johns Hopkins 4.Eli Lilly and CO - B;
RF21 University School of
Medicine
42 Wood Kirkham 2.Alpha Tec - A; 3.TranS1 - B, Globus Inc. - A; 6.Globus
Inc. - A;
Moderator Wojewnik Bartoz Loyola University 1. Depuy-Synthes-A, 7. Polish-American Medical
Session 3 Medical Center Society-N
23, 40 Xiao Roy
RF15 Yacob Alem
P09 Yadhati Akshay SUNY Upstate

Medical University
38, P07 Yang JaeWon Brown University,
Warren Alpert
Medical School
04, 26, 28, 35, Yom Kelly
RF15
RF06 Yoo Jung Oregon Health and 4.Orthofix - B; 6.Osiris Therapeutics - A; 7.Korean
Science University American Spine Society - A;
P21, P36 Yoon Jang Mayo Clinic 3.MedCyclops - A;
13 Yu Elizabeth Ohio State 2.Allosource - A; 4.Nuvasive - B;

University
P08, RF14 Yu Warren George Washington 2.SpineArt, Inc - A, Seaspine, Inc - B, Xenco, Inc -
University A, Choice Spine - B; 6.Interventional Spine - B;
Department of
Orthopaedic
Surgery
42 Yu Yan HMS/MGH
244

24 Yuan Philip Memorial 4.mesoblast - B;
Orthopedic Surgical
Group
P11 Yun Chawon Northwestern
University
Department of
Orthopaedic
Surgery
P11 Yun Jonghwa
Moderator Zdeblick Thomas University of 2. MiMedx, Level=A; 3. MiMedx, Level=C; 6. Medtronic,

Session 1 Wisconsin Level=E
RF17 Zhang Chengmin
P03 Zhang Chong University of Utah
P04 Zhang Yue University of Utah
P26 Zheng Yi Hong
RF17 Zhou Qiang Southwest Hospital,

Third Military
Medical University
245
Lumbar Spine Research Society Membership Directory
William Abdu, MD Paul Arnold, MD
Dartmouth-Hitchcock Medical Center University of Kansas Med Center
Dept of Orthopedics 3901 Rainbow Blvd
One Medical Center Drive Mail Stop 3021
Lebanon, NH 03756 Kansas City, KS 66160
USA USA
Orthopedics Neurosurgery
Founding Member Since 2008 Founding Member Since 2008
William.A.Abdu@hitchcock.org parnold@kumc.edu

Todd Albert, MD Jamie Baisden, MD & FACS
Hospital for Special Surgery Medical College of Wisconsin
Dept of Ortho Surgery Dept of Neurosurgery
535 East 70th St 9200 W. Wisconsin Ave
New York, NY 10310 Milwaukee, WI 53226
USA USA
Founding Member Since 2008 Member Since 2011
212-774-7522 jbaisden@mcw.edu
albertt@hss.edu
tjsurg@aol.com

Paul A. Anderson, MD Kevin Baker, PhD
University of Wisconsin Beaumont Research Institute
Dept of Orthopedics 3811 W 13 Mile Rd.
1685 Highland Ave Suite 404
Madison, WI 53705 Royal Oak, MI 48073
USA USA
Orthopedics Orthopedics
Founding Member Since 2008 Basic Science Member Since 2012
anderson@ortho.wisc.edu kevin.baker@beaumont.edu

David Anderson, MD Robert Banco, MD
Orthocarolina Spine Center Boston Spine Group LLC
11189 Villa Trace Pl 25 Washington St.
Charlotte, NC 28277 Unit 1B
USA Wellesley, MA 2481
Orthopedics USA
Member Since 2014 Orthopedics
267-625-1981 Founding Member Since 2008
david.anderson@orthocarolina.com 617-219-6300
rbanco@partners.org

246
Edward Benzel, MD Jacob Buchowski, MD & MS
Hospital for Special Surgery Washington University in St. Louis
Dept of Neurosurgery 4255 Euclid Ave
9500 Euclid Ave/S40 Campus Box 8233
Cleveland, OH 44195 St. Louis, MO 63110
USA USA
Neurosurgery Orthopedics
BENZELE@ccf.org buchowskij@wudosis.wustl.edu

Maxwell Boakye, MD Tuan Bui, MD
University of Louisville OrthoAtlanta
220 Abraham Flexner Way 771 Old Norcross Rd
Louisville, KY 40202 #155
USA Lawrenceville, GA 30046
Neurosurgery USA
max.boakye@louisville.edu Member Since 2016
678-957-0757
tuanlebui@gmail.com

Scott Boden, MD Zorica Buser, PhD
The Emory Spine Center University of Southern California
59 Executive Park South 2011 Zonal Ave, HMR710
Atlanta, GA 30329 Los Angeles, CA 90033
USA USA
Founding Member Since 2008 Basic Science Member Since 2015
sboden@emory.edu zbuser@usc.edu

Darrel Brodke, MD Frank Cammisa Jr., MD
University of Utah Hospital for Special Surgery
Dept of Orthopaedics 523 East 72nd St
590 Wakara Way 3rd Floor
Salt Lake City, UT 84108 New York, NY 10021
USA USA
801-587-5450 212-606-1946
darrel.brodke@hsc.utah.edu cammisaf@hss.edu

247
Gregory Carlson, MD Boyle Cheng, PhD
Orthopaedic Specialties Institute Drexel University
280 S. Main St. Suite 200 AGH Dept of Neurosurgery
Orange, CA 92868 Suite 302
USA 320 East North Ave
Orthopedics Pittsburgh, PA 15212
Founding Member Since 2008 USA
gcarlson@ocspine.com Neurosurgery
Founding Basic Science Member Since
2008
boylecheng@yahoo.com
Boyle.CHENG@ahn.org

Jens Chapman, MD Ivan Cheng, MD
University of Washington Stanford
325 Ninth Ave 450 Broadway St.
Box 359798 MC: 6342
Seattle, WA 98104 Redwood City, CA 94063
USA USA
206-214-6105 650-721-7616
jens.chapman@swedish.org ivan.cheng@stanford.edu

Todd Matthew Chapman, MD Alexander Ching, MD
OrthoCarolina Oregon Spine Care
2001 Randolph Rd 4304 SW 36th Pl
Charlotte, NC 28207 Portland, OR 97221
USA USA
Member Since 2016 Member Since 2014
704-323-3524 chingspinedoc@gmail.com
matt.chapman@orthocarolina.com
todd.chapman@orthocarolina.com

248
Michael Chioffe, MD Bradford Currier, MD
Spine Consultants Mayo Clinic
1300 Higgins Rd Dept of Orthopedics
Suite 200 200 1st St. SW
Park Ridge, IL 60068 Rochester, MN 55905
USA USA
Member Since 2016 Founding Member Since 2008
773-321-2800 currier.bradford@mayo.edu
michaelc@spineconsultants.org

Dean Chou, MD Scott Daffner, MD
University of California San Francisco West Virginia University School of
Medical Center Medicine
505 Parnassus Ave Dept of Orthopaedics
Box 0112 P.O. Box 9196
San Francisco, CA 94143 Morgantown, WV 26505
USA USA
415-353-2348 304-293-2779
Dean.Chou@ucsf.edu sdaffner@hsc.wvu.edu

Michael Cluck, MD & PhD Andrew Dailey, MD
Bay Area Spine Care University of Utah
455 O'Connor Drive Dept of Neurosurgery
Ste 360 175 North Medical Drive East
San Jose, CA 95128 Salt Lake City, UT 84132
USA USA
Orthopedics Other
408-295-2200 801-581-6908
mwcluck@gmail.com andrew.dailey@hsc.utah.edu

Jeffrey Coe, MD Bruce V. Darden II, MD
Silicon Valley Spine Institute Orthocarolina Spine Center
221 East Hacienda Ave 2001 Randolph Rd
Ste A Charlotte, NC 28207
Campbell, CA 95008 USA
USA Orthopedics
Orthopedics Founding Member Since 2008
Founding Member Since 2009 704-323-3657
408-376-3300 bruce.darden@orthocarolina.co
jcoe@svspine.com
249
Michael Daubs, MD William Donaldson, MD
University of Nevada School of Medicine University of Pittsburgh Medical Center
Department of Orthopaedics 3471 Fifth Ave
1701 W Charleston Blvd Suite 1010
Suite 490 Pittsburgh, PA 15213
Las Vegas, NV 89102 USA
USA Orthopedics
702-671-2394 donaldsonwf@upmc.edu
Mdaubs@medicine.nevada.edu

Jeffrey Dick, MD Daryll Dykes, MD, JD, PhD
Twin Cities Orthopedics Spine Consultants of Minnesota
18709 Ridgewood Road PO Box 8598
Deephaven, MN 55391 Minneapolis, MN 55408
USA USA
jcdick@comcast.net ddykes@spinemn.com

Shah-Nawaz Dodwad, MD Sanford Emery, MD
The University of Texas Health Science West Virginia University
Center at Houston Dept of Orthopedics
6400 Fannin 1 Medical Drive
Suite 2250 PO Box 9196
Houston, TX 77030 Morgantown, WV 26506-9196
USA USA
713-486-7530 304-293-1170
smdodwad@gmail.com semery@hsc.wvu.edu

Mark Erwin, PhD
Toronto Western Hosp.
399 Bathurst St.
Toronto, Ontario M5T 2S8
Canada
Research
Basic Science Member Since 2013
mark.erwin@utoronto.ca

250
Ira Fedder, MD Michael Finn, MD
Towson Orthopaedic Associates University of Colorado School of
7505 Osler Dr. Medicine
Suite 104 Dept of Neurosurgery
Belto, MD 21204 12631 E. 17th Ave
USA C307
Orthopedics Aurora, CO 80046
Member Since 2013 USA
drfedder@gmail.com Neurosurgery
Member Since 2012
michael.finn@ucdenver.edu

Michael Fehlings, MD Charla Fischer, MD
Toronto Western Hosp NY Presbyterian
399 Bathurst St. 622 W 168th St
WW4-449 PH 1154
Toronto, Ontario M5T 2S8 New York, NY 10032
Canada USA
416-603-5072 212-305-9192
michael.fehlings@uhn.ca cdr2112@columbia.edu
cdr2112@cumc.columbia.edu

Richard Fessler, MD Jeffrey Fischgrund, MD
Rush University Medical Center William Beaumont Hospital
Chicago, IL 60611 3601 West 13 Mile Rd
USA 2nd FL
Neurosurgery Royal Oak, MI 48072
Founding Member Since 2008 USA
jenna_feld@rush.edu Orthopedics
Founding Member Since 2008
248-701-2029
jsfischgrund37@gmail.com
jsfischgrund@comcast.net

Jeremy Fogelson, MD
Mayo Clinic
200 First Street SW
Rochester, MN 55905
USA
Neurosurgery
Member Since 2015
fogelson.jeremy@mayo.edu
251
Todd Francis, MD Alexander Ghanayem, MD
Hillcrest Hospital Loyola University Medical Center
6780 Mayfield Heights 2160 South First Ave
HCS1-725 Bldg 105 Ste 1700
Mayfield Heights, OH 44143 Maywood, IL 60153
USA USA
440-312-6100 708-216-3475
aghanay@lumc.edu

Steven Garfin, MD Jeffrey Goldstein, MD
Department of Orthopaedic Surgery NYU Hospital for Joint Diseases
200 W Arbor Drive 16 Manursing Way
Mail 8894 Rye, NY 10580
San Diego, CA 92103 USA
USA Orthopedics
Founding Member Since 2008 jeffrey.goldstein@nyumc.org
619-543-2644
sgarfin@ucsd.edu

Timothy Garvey, MD Ira Goldstein, MD
Twin Cities Spine Center Rutgers The State University of New
913 East 26th St. Jersey
Piper Building Ste 600 90 Bergen Street Suite 8100, DOC
Minneapolis, MN 55404 Newark, NJ 07103
USA USA
612-775-6200 973-972-8211
tagarvey@tcspine.com ira.goldstein@rutgers.edu

Michael Gerling, MD Jonathan Grauer, MD
NYU-Hosptial for Joint Disease Yale University School of Medicine
Dept of Orthopaedics Dept of Orthopedics
150 55th St. PO Box 208071
Rm#4823 New Haven, CT 06520-8071
Brooklyn, NY 11220 USA
USA Orthopedics
Orthopedics Member Since 2014
Member Since 2011 203-228-2622
212-882-1110 jonathan.grauer@yale.edu
michael.gerling@nyumc.org
252
Gregory Graziano, MD D. Kojo Hamilton, MD
Henry Ford Health Systems University of Pittsburgh School of
Dept of Orthopedics Medicine/Medical Center
2799 W. Grand Blvd. 200 Lothrop St
K12 Suite B400
Detroit, MI 48202 Pittsburgh, PA 15213
USA USA
313-916-3674 412-471-4771
GGRAZIA1@hfhs.org dkojoh@gmail.com

Raymond Hah, MD James Harrop, MD
Keck Medical Center of University of Thomas Jefferson University
Southern California 909 Walnut Street
1450 San Pablo St Philadelphia, PA 19107
#5400 USA
Los Angelos, CA 90033 Neurosurgery
USA Founding Member Since 2008
Orthopedics 215-380-9355
Member Since 2016 james.harrop@jefferson.edu
323-865-6833
ray.hah@med.usc.edu

Regis Haid, MD Robert Hart, MD
Atlanta Brain and Spine Care Oregon Health and Science University
2001 Peachtree Rd NE Orthopedics
Ste 575 3181 SW Sam Jackson Park
Atlanta, GA 30309 OP31
USA Portland, OR 97239
Neurosurgery USA
Founding Member Since 2008 Orthopedics
404-788-8398 Member Since 2009
rhaid@atlantabrainandspine.com

253
Robert F. Heary, MD Terrence Holekamp, MD, PhD
Rutgers The State University of New Neurospine Institute
Jersey 2706 Rew Circle
90 Bergent Street Suite 100
Suite 8100 Ocoee, FL 34761-4215
Newark, NJ 07103 USA
USA Neurosurgery
Neurosurgery Member Since 2016
heary@rutgers.edu
heary@njms.rutgers.edu

John G. Heller, MD Wellington Hsu, MD
The Emory Spine Center Northwestern University Feinberg
59 Executive Park South School of Medicine
Atlanta, GA 30329 Dept of Orthopedic Surgery
USA 676 N. St. Clair St
Orthopedics Ste 1350
Founding Member Since 2008 Chicago, IL 60611
john.heller@emoryhealthcare.org USA
Orthopedics
Member Since 2009
whsu@nmff.org

Joshua Heller, MD Erin Hsu, PhD
Thomas Jefferson University Northwestern University
909 Walnut St. 676 N St Clair St. Suite 1350
Philadelphia, PA 19107 Chicago, IL 60611
USA USA
Member Since 2014 Basic Science Member Since 2015
267-250-1533 310-903-7316
joshua.heller@jefferson.edu erinkhsu@gmail.com

Alan Hilibrand, MD Serena Hu, MD
The Rothman Institute Stanford University
925 Chestnut Street 450 Broadway St
Philadelphia, PA 19107 MC6243
USA Redwood City, CA 94063
Orthopedics USA
ahilibrand@gmail.com Member Since 2016
acad-650-721-7616, clin-650-725-5905
shu3@stanford.edu
254
Andrew Indresano, MD Thomas Kesman, MD
Orthopedic Center of Corpus Christi Reliant Medical Group Orthopedics
6118 Parkway Dr 19 Morningside Dr
Corpus Christi, TX 78414 Shrewsbury, MA 01545
USA USA
indresano8@gmail.com 508-368-3140
thomas.kesman@gmail.com

Louis Jenis, MD David Kim, MD
Massachusetts General Hospital New England Baptist Hospital/Tufts
Department of Orthopaedic Surgery University School of Medicine
55 Fruit Street 125 Parker Hill Ave
Suite 3800 Boston, MA 02120
Boston, MA 02114 USA
USA Orthopedics
617-726-5370 dhkim@nebh.org
ljenis@partners.org

Iain Kalfas, MD Jason Koreckij, MD
Cleveland Clinic Columbia Orthopaedic Group
Dept of Neurosurgery (S-40) 1 South Keene St.
9500 Euclid Ave. Columbia, MD 65201
S-40 USA
Cleveland, OH 44195 Orthopedics
USA Member Since 2013
Neurosurgery 816-695-9385
Founding Member Since 2008 jasonkoreckij@hotmail.com
216-444-9064
kalfasi@ccf.org

Daniel Kang, MD Theodore Koreckij, MD
Madigan Army Medical Center University of Missouri - Kansas City
9040 Jackson Avenue Medical Center
Tacoma, WA 98431 3651 College Blvd
USA Leawood, KS 66211
Orthopedics USA
253-968-1790 Member Since 2015
daniel.g.kang@gmail.com 816-695-9583
tkoreckij@gmail.com
255
Paul Kraemer, MD Michael Lee, MD
Indiana Spine Group University of Chicago Medical Center
PC Dept of Ortho
13225 N. Meridian St. 5841 S Maryland Ave
Carmel, IN 46032 Ste MC6051
USA Chicago, IL 60637-1654
Orthopedics USA
317-228-7000 Member Since 2012
pkraemer@indianaspinegroup.com 773-834-3531
mlee5@bsd.uchicago.edu

William Lavelle, MD Ronald Lehman, MD
SUNY Upstate Medical University The Spine Hospital New York
Dept of Orthopedics Presbyterian/The Allen Hospital
6620 Fly Road 5141 Broadway
Suite 200 3FW-018
East Syracuse, NY 13057 New York, NY 10034
USA USA
518-669-7247 212-932-5067
lavellwf@yahoo.com ronaldalehman@yahoo.com

Brandon Lawrence, MD Chi Lim, MD
University of Utah Orthopaedic Associates, PA
590 Wakara Way 1330 Boiling Springs Rd
Salt Lake City, UT 84108 Suite 1600
USA Spartonburg, SC 29303
Orthopedics USA
801-587-5450 Member Since 2016
brandon.lawrence@hsc.utah.edu 864-582-6396
clim06@gmail.com
Eric Laxer, MD
OrthoCarolina Spine Center
2001 Randolph Rd
Charlotte, NC 28207
USA
Orthopedics
Member Since 2015
704-323-3657
eric.laxer@orthocarolina.com

256
Larry Lo, MD, MHS Ankit Mehta, MD
Columbia University College of University of Illinois at Chicago
Physicians and Surgeons 912 S Wood St
Department of Neurological Surgery 4N NPI
College of Physicians & Surgeons Chicago, IL 60612
710 W 168th St USA
Rm 517 Neurosurgery
New York, NY 10032 Member Since 2016
USA 847-826-6280
Neurosurgery ankitm@uic.edu
Member-1st yr in practise Since 2016
shengfu.lo@gmail.com

Kamran Majid, MD Marco Mendoza, MD
Oakland Medical Center OrthoCarolina
Department of Orthopaedics 2001 Randolph Rd
3600 Broadway Charlotte, NC 28207
Floor 1 USA
Oakland, CA 94611 Orthopaedics
USA Fellow Member Since 2016
Orthopedics 859-489-5132
Member Since 2010 mcmend2@gmail.com
510-752-6565
kmajid2001@yahoo.com

Hemil Maniar, MD Alden Milam, MD
Geisinger Health Systems Orthocarolina Spine Center
Department of Orthopaedics 2001 Randolph Rd
4200 Hospital Road Charlotte, NC 28207
Coal Township, PA 17866 USA
USA Orthopedics
Orthopaedics Member Since 2013
Member-1st yr in practise Since 2016 alden.milam@orthocarolina.com
570-594-5688
hemilmaniar@gmail.com

257
James Mok, MD Ahmad Nassr, MD
University of Chicago Mayo Clinic
5841 S. Maryland Ave. 200 First St. SW
MC3079 Rochester, MN 55905
Chicago, IL 60611 USA
USA Orthopedics
Member Since 2016 507-538-0514
415-971-6679 nassr.ahmad@mayo.edu
jmok@bsd.uchicago.edu

Don Moore, MD Russ Nockels, MD
Cleveland Clinic Loyola University Medical Center
34 Executive Drive 2160 South First Ave
Suite B Maywood, IL 60153
Norwalk, OH 44857 USA
USA Orthopedics
Founding Member Since 2008 rpnockels@mac.com
419-660-0198 PKOWALCZYK@lumc.edu
keystone2017@gmail.com

Timothy Moore, MD Richard North, MD
MetroHealth Medical Center The Sandra and Malcolm Berman Brain
Dept Of Orthopaedic Surgery & Spine Institute
2500 MetroHealth Drive 5051 Greenspring Ave
Cleveland, OH 44109 Suite 200
USA Baltimore, MD 21209
Orthopedics USA
Member Since 2011 Neurosurgery
tmoorefx@gmail.com Founding Member Since 2008
drrnorth@hotmail.com

Praveen Mummaneni, MD Christopher O'Boynick, MD
University of California San Francisco Premier Care Othopedics and Sports
Medical Center Medicine
505 Parnassus Ave 12639 Old Tesson Rd
M 780 Suite 115
San Francisco, CA 94143 St. Louis, MO 63128
USA USA
415-353-3998 314-849-0311
praveen.mummaneni@ucsf.edu Coboynick@signaturehealth.net
258
Joseph O'Brien, MD Rod Oskouian, MD
The George Washington University Swedish Medical Center
Dept of Orthopaedic Surgery 550 17th Ave
2150 Pennsylvania Ave NW, 4724 23rd Suite 500
Street North Seattle, WA 98122
Gwu mfa USA
Washington, Arlington, DC, VA 20037, Neurosurgery
22207 Member Since 2014
USA rod.oskouian@swedish.org
Orthopedics
Member Since 2011
202-741-3307 202-285-0016
obrienjr@gmail.com
jobrien@mfa.gwu.edu
jobrien@mfa.gwu.edu

Douglas Orndorff, MD Daniel Park, MD
Spine Colorado, PC Michigan Orthopedic Institute
1 Mercado St 26025 Lahser Rd.
Suite 200 Southfield, MI 48033
Durango, CO 81301 USA
USA Orthopedics
Member Since 2010 daniel@danielparkmd.com
970-375-3643
dorndorff@spinecolorado.com
lrome@spinecolorado.com

Douglas Orr, MD Alpesh Patel, MD
Center for Spine Health Northwestern School of Medicine
Lutheran Hospital 2C 676 N St. Claire St.
1730 West 25th St. Suite 1350
Cleveland, OH 44113 Chicago, IL 60611
USA USA
orrd@ccf.org 312-695-5902
alpesh2@gmail.com

259
Tushar Patel, MD Frank Phillips, MD
OrthoVirginia Rush University Medical Center
3620 Joseph Siewick Dr 1611 W. Harrison St
Fairfax, VA 22033 Suite 300
USA Chicago, IL 60612
Orthopedics USA
orthopod203@hotmail.com Founding Member Since 2008
frank.phillips@rushortho.com

Rakesh Patel, MD David Polly, MD
University of Michigan University of Minnesota
Dept of Orthopedics 2450 Riverside Ave S. R200
111 North Ashly St. Apt 912 Minneapolis, MN 55454
Ann Arbor, MI 48104 USA
USA Orthopedics
Member Since 2010 pollydw@umn.edu
rockpatelmd@gmail.com

Ronjon Paul, MD Marina Protopapas, DO
DuPage Medical Center Capitol Spine and Pain Centers
711 S. Julian Street 13890 Braddock Rd
Naperville, IL 60540 Ste 100
USA Centreville, VA 20121
Orthopedics USA
Founding Member Since 2008 Pain Management
ronjonpaul@hotmail.com Member Since 2014
703-738-4339
protopapasm@treatingpain.com

Mick Perez-Cruet, MD Raj Rao, MD
Oakland University Dept of Orthopedics
William Beaumont Hospital 2300 M Street Northwest
3677 West 13 Mile Rd. #206 5th Floor
Royal Oak, MI 48073 Washington, DC 20037
USA USA
perezcruet@yahoo.com Rrao@mfa.gwu.edu

260
Brandon Rebholz, MD Comron Saifi, MD
Medical College of Wisconsin Rush University Medical Center
9200 W. Wisconsin Avenue 1611 West Harrision St
PO Box 26099 Suite 300
Milwaukee, WI 53226 Chicago, IL 60612
USA USA
Orthopedics Orthopaedics
Member Since 2016 Fellow Member Since 2016
414-805-7425 csaifi@gmail.com
brebholz@mcw.edu

Glenn Rechtine, MD Rick C. Sasso, MD
Rochester Medical Center Indiana Spine Group
7 Braemar Way 13225 N. Meridian
Pittsford, NY 14534 Carmel, IN 46032
USA USA
grechtine@gmail.com 317-228-7000
rsasso@indianaspinegroup.com

Bernard Rerri, Jason Savage, MD
Bonutti Clinic Northwestern University Feinberg
1303 West Evergreen Avenue School of Medicine
Suite #101/PO Box 1387 Dept of Orthopaedic Surgery
Effingham, IL 62401 676 N. St. Clair St.
USA Ste 1350
Orthopedics Chicago, IL 60611
brerri@bonutticlinic.com Orthopedics
Member Since 2013
savagej2@ccf.org

Alfred Rhyne, MD Daniel Sciubba, MD
Orthocarolina Spine Center Johns Hopkins University
2001 Randolph Rd Dept of Neurosurgery
Charlotte, NC 28207 Meyer 5-85
USA 600 N. Wolfe St.
Orthopedics Baltimore, MD 21287
704-323-3658 Neurosurgery
alfred.rhyne@orthocarolina.com Member Since 2014
410-502-5077
dsciubb1@jhmi.edu
261
Cara Sedney, MD Neal Shonnard, MD
West Virginia University Rainer Orthopedic Institute
Dept of Neurosurgery 4954 N Scenic View Ln
HSU PO Box 9183 Tacoma, WA 98407
Morgantown, WV 26505 USA
USA Orthopedics
Neurosurgery Member Since 2015
Member Since 2016 253-219-5228
304-293-5041 n.shonnard@proliancesurgeons.com
csedney@hsc.wvu.edu

Bradley Segebarth, MD Michael Silverstein, MD
Orthocarolina Spine Center The Cleveland Clinic Foundation
2001 Randolph Rd 12911 Cedar Rd
Charlotte, NC 28207 Cleveland Heights, OH 44118
USA USA
Orthopedics Orthopaedics
Member Since 2014 Resident Member Since 2016
brad.segebarth@orthocarolina.com 954-881-1930
msilve28@gmail.com

Jonathan Sembrano, MD Kern Singh, MD
University of Minnesota Medical School Rush University Medical Center
Dept of Orthopaedic Surgery 1611 W. Harrison St
2450 Riverside Ave S Chicago, IL 60612
R200 USA
Minneapolis, MN 55454 Orthopedics
USA Member Since 2012
Orthopedics kern.singh@rushortho.com
Member Since 2015
612-273-7991
sembr001@umn.edu
cbilitz@umphysicians.umn.edu

Christopher Shaffrey, MD Justin Smith, MD
University of Virginia Medical Center University of Virginia
Box 800212 PO Box 800212
Charlottesville, VA 22908 Charlottesville, VA 22908
USA USA
Neurosurgery Neurosurgery
434-243-9714 434-243-6339
cis8z@virginia.edu jss7f@hscmail.mcc.virginia.edu
262
Harvey Smith, MD Michael Steinmetz, MD
University of Pennsylvania Cleveland Clinic
Dept of Orthopedic Surgery 9500 Euclid Ave
3737 Market St 6th Fl S40
Philadelphia, PA 19104 Cleveland, OH 44195
USA USA
harveysmith27@gmail.com 216-445-6797
steinmm@ccf.org

Zachary Smith, MD William Tontz, MD
Feinberg School of Medicine California Orthopaedic Institute
Northwestern University 4581 Granger St
Dept of Neurological Surgery San Diego, CA 92107
676 N St Clair St. USA
Suite 2210 Orthopedics
Chicago, IL 60611 Member Since 2013
USA 619-578-4451
Neurosurgery billtontz@gmail.com
Member Since 2016
312-371-1175
zmith1@nm.org

Leo Spector, MD Vincent Traynelis, MD
OrthoCarolina Rush University Medical Center
2001 Randolph Rd Dept of Neurosurgery
Charlotte, NC 28207 1725 W Harrison St
USA Suite 1115
Orthopedics Chicago, IL 60611
704-323-3657 Neurosurgery
leo.spector@orthocarolina.com Founding Member Since 2008
leo.spectormd@orthocarolina.com vincent_traynelis@rush.edu

Ryan Spiker,
University of Utah
590 Wakara Way
Salt Lake City , UT 84108
USA
Orthopedics
Member Since 2016
801-587-5450
Ryan.Spiker@hsc.utah.edu
263
Clifford Tribus, MD Timothy Witham, MD
University of Wisconsin The Johns Hopkins Hospital
Dept of Orthopedics 600 North Wolfe St Meyer 7-113
1685 Highland Ave Baltimore, MD 21287
Madison, WI 53705 USA
USA Neurosurgery
tribus@ortho.wisc.edu twitham2@jhmi.edu

Scott Tromanhauser, MD Bartosz Wojewnik, MD
New England Baptist Hospital Loyola University Medical Center
125 Parker Hill Ave 2160 South First Ave
Converse 4 Blg 105 Ste 1700
Boston, MA 02120 Maywood, IL 60153
USA USA
617-754-5744 708-216-5728
stromanh@nebh.org bart.wojewnik@gmail.com
tromanhauser@gmail.com

Jeffrey Wang, MD Daniel Yanni, MD
University of Southern California Spine Neurosurgeon and Spine Surgeon
Center 351 Hopsital Rd
1520 San Pablo St. Suite 218
Suite 2000 Newport Beach, CA 92663
Los Angeles, CA 90033 USA
USA Neurosurgery
323-442-5303 dyanni@uci.edu
Jeffrey.Wang@med.usc.edu

Seth Williams, MD Jim Youssef, MD
University of Wisconsin Spine Colorado, PC
Dept of Orthopedics and Rehabilitation 1 Mercado St
1685 Highland Ave Suite 200
Madison, WI 53704 Durango, CO 81301
USA USA
608-695-5159 970-382-9500
swilliams@ortho.wisc.edu jyoussef@spinecolorado.com
264
Thomas Zdeblick, MD
University of Wisconsin
Dept of Orthopedics
1685 Highland Ave
Madison, WI 53705
USA
Orthopedics
608-263-3178
zdeblick@ortho.wisc.edu

Seth Zeidman, MD
Rochester Brain and Spine
400 Red Creek Dr
#120
Rochester, NY 14623
USA
Neurosurgery
drseth@frontiernet.net

265

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Table

Continuing Medical Education Credit ---------------------------------------------------------------------------- 4

WiFi Information ------------------------------------------------------------------------------------------------------ 4

Meeting Evaluations ------------------------------------------------------------------------------------------------- 4

Lumbar Spine Research Society at 10 Years -------------------------------------------------------------------- 5

Research Fund Information ---------------------------------------------------------------------------------------- 6

Officers and Committee List ---------------------------------------------------------------------------------------- 8

10th Annual Meeting Program Schedule ---------------------------------------------------------------------- 10

Electronic Poster Index -------------------------------------------------------------------------------------------- 26

Paper Abstracts ------------------------------------------------------------------------------------------------------ 31

Rapid Fire Abstracts ----------------------------------------------------------------------------------------------- 104

Electronic Poster Abstracts -------------------------------------------------------------------------------------- 152

Alphabetical Disclosure Listing and Author Index ---------------------------------------------------------- 218

Membership Directory ------------------------------------------------------------------------------------------- 246

CME’s for Neurosurgeons

Meeting Wi-Fi Network: Sofitel Meeting

2017 Annual Meeting INFORMATION

Completed evaluations are required to receive a certificate of attendance.

Thomas A. Zdeblick, M.D.

Please feel free to contact me with any questions.

Thank you for your contribution to the Research Fund.

DONATE TO THE RESEARCH FUND

Session #1 Blood Loss / Thromboembolism

SYMPOSIUM #1 Trauma – AOSpine

9:22-9:42 Breakout Poster Session -1

Session #4 Rapid Fire Presentations: General Spine

Rapid Fire Presentations: Complications

Session #5 Bundled Payments

12:00-1:00 Attendees Luncheon (3rd Floor)

Members Business Meeting (1st Floor – Cigale)

Session #8 Rapid Fire Presentations: Imaging

Rapid Fire Presentations: Surgical Techniques

Session #10 Minimally Invasive Surgery

Session # 11 Minimally Invasive Techniques

Symposium #3 Intra-Operative Imaging/Tools for Lumbar Surgery

SESSION #13 Patient Satisfaction

Session #15 Lumbar Degenerative

Session #16 Rapid Fire Presentations- Preclinical Studies / Other

Rapid Fire Presentations- Deformity

1. Speakers Bureau/Paid presentations

16 Ailon Tamir Vancouver Spine (n.)

23 Alonso Andrea Case Western 2.Pfizer - D, Zymtronix, LLC - A; 3.Zymtronix, LLC -

16 Ames Christopher University of 2.DePuy - B, Stryker - B, Medtronic - A; 3.Stryker -

P39 Barkoh Kaku (n.)

07, 37 Barth Kathryn Northwestern (n.)

P31, RF09 Bomberger Thomas (n.)

09 Bono Olivia (n.)

RF01 Boody Barrett Northwestern (n.)

02, 25 Boyajian Haroutioun (n.)

P03, P04, RF12 Brodke Darrel 2.Vallum - A; 5.Amedica - C, DePuy Synthes -

RF19 Brooks Daina 2.Globus Medical - C; 3.Globus Medical - A;

19, 41, P15, Brown Luke (n.)

P39 Buser Zorica University of 2.Xenco Medical (consultancy) - B, AO Spine

P20 Cao Na George Washington (n.)

P01 Cazzulino Alejandro (n.)

RF13 Cho Woojin Montefiore Medical (n.)

07, 37 Chun Danielle Northwestern (n.)

24 DePalma Michael Virginia iSpine 2.Medtronic - B, Mesoblast - A, Halyard - B, AnGes -

17 Diebo Bassel (n.)

Moderator Dodwad Shah-Nawaz The University of 1. Nuvasive - A, Stryker - A 2. Stryker - A,

21, RF29 Dowdell James (n.)

P06 Drain Joseph (n.)

29, P24, P37 Drazin Doniel Swedish (n.)