65SProceedings of the NASS 22nd Annual Meeting / The Spine Journal 7 (2007) 1S–163S

neck after MVA are usually asked about previous axial pain problems and

other relevant co-morbid conditions. This information is used to formulate

diagnosis and treatment plans. A validity-analysis of previous axial pain

history and relevant co-morbidities associated with MVA has not been pre-

viously evaluated. The validity of the self-reported history in this clinical

context is not clear but assumed to be high.

PURPOSE: To establish the validity of certain self-reported history in

patients with back or neck pain attributed to an MVA.

STUDY DESIGN/SETTING: Validation study of crucial elements of the

patient history obtained after MVA using internal (chart audit) and external

(age and sex matched population data) as Gold Standard reference.

PATIENT SAMPLE: Medium sized clinical cohort of patients without

fracture or dislocation seen within 3 months after an MVA in a university

spine clinic.

OUTCOME MEASURES: Response to standardized questionnaires re:

previous back or neck pain; previous psychological distress; previous il-

licit drug usage; previous alcohol abuse; other chronic pain conditions;

perceived fault of the MVA; and whether a compensation claim has

been filed.

METHODS: A consecutive cohort of patients seen from 1998–2004 for

evaluation of back or neck/shoulder pain reportedly due to a MVA was

enrolled. All clinic patients completed standardized questionnaires. The

prevalence of self-reported pre-MVA axial pain and co-morbid condi-

tions (drug, alcohol and psychological problems) were compared against

the age and sex matched prevalence determined by the 2005 US Depart-

ment of Health and Human Services National Surveys on Drug Use and

Health (external gold standard). A randomly selected subgroup of 100

patients’ previous medical records were also audited (internal gold stan-

dard) and compared to post-MVA description of pre-accident health.

RESULTS: 422 subjects were enrolled and 85 of 100 random audits were

completed. In subjects perceiving the MVA to be someone else’s fault, the

reported prevalence of previous axial pain was markedly below matched

data for population prevalence (25% of expected prevalence, p!0.0001).

Similar findings were observed for psychological problems (40%,

p!0.01), illicit drug use (21%, p!0.01) and alcohol abuse (15%,

p!0.01). In subjects reporting the MVA was either their ‘‘own fault’’ or

‘‘no one’s fault’’, this effect was smaller in all dimensions. In 68% of

the random audits, co-morbid conditions denied in the post-accident his-

tory (previous axial pain, drug/alcohol abuse, psychological diagnoses)

were found, and these were more frequently found in subjects perceiving

someone to be at fault for the MVA.

CONCLUSIONS: In patients being seen for continued pain related to

an MVA, the reporting of previous axial pain and co-morbid conditions

(drug, alcohol and psychological conditions) is markedly below the ex-

pected prevalence in age and sex-matched populations. Random audit

of responses compared to previous medical records showed a majority

of patients under-reported the presence of these conditions. This effect

is seen most prominently in patients perceiving the accident to be an-

other party’s fault and in those filing compensation claims. The valid-

ity of self-reported previous axial pain and co-morbid conditions,

particularly in a compensation setting, appeared poor in this

population.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2007.07.160

136. Does Collaboration Change Surgical Decisions in Spine

Surgery?

James Reynolds, MD1, Paul Slosar, Jr., MD1, Noel Goldthwaite, MD1,

Edward Sun, MD1; 1San Francisco Spine Institute / SpineCare Medical

Group, Daly City, CA, USA

BACKGROUND CONTEXT: There has been collaboration for the pur-

pose of improving surgical decisions in spine surgery for many years in

many different formats, including case presentations and case reviews.

The effect of collaboration on the surgical decision making process, how-

ever, has never been evaluated. Recently, online peer to peer collaboration

has become popular. In our practice it is routine that the attending surgeon

present all planned surgeries in a multi-disciplinary face to face format.

The effects of such collaboration on the final surgery decision have not

been previously investigated.

PURPOSE: To determine the effects of collaboration on potential changes

in surgical decisions.

STUDY DESIGN/SETTING: Consecutive review of scheduled surgical

cases.

PATIENT SAMPLE: All scheduled surgeries with the exception of urgent

cases and spinal cord stimulators.

OUTCOME MEASURES: Any changes to the original surgical plan as

a result of collaboration. Changes were divided into major or minor. A ma-

jor change was classified as a change in approach, surgical level, modifi-

cation (i.e. addition or subtraction of instrumentation, fusion, fusion

techniques such as addition or subtraction of biologic or autogenously

graft, or decompression), or cancellation of the procedure. A minor change

was classified as different instrumentation, additional testing before sur-

gery, addition or subtraction of monitoring and intraoperative imaging,

or a positioning change.

METHODS: All elective surgical cases were reviewed in a regularly

scheduled case conference. Each attending surgeon completed a surgery

scheduling form that included: patient name, diagnosis, planned procedure,

positioning, instrumentation, additional equipment, and additional moni-

toring. Other details recorded included surgical levels, approach, need

for decompression and need for fusion. Surgical procedures were subdi-

vided into simple and complex. Simple procedures included one or two

level decompressions, one level fusions, kyphoplasty, and hardware re-

moval. All other procedures were considered complex. The surgeon pre-

sented the case including history, physical examination, imaging studies,

and the planned procedure. All cases were then discussed. If there was dis-

agreement, then discussion occurred about the recommended procedure.

For each case consensus was reached. If the procedure was changed, the

change was classified as major or minor.

RESULTS: A total of 56 cases were reviewed. There were 35 complex

and 21 simple procedures. Changes from the original plan occurred in

7 (12.5%) of all cases presented. There were 5 major changes and 2

minor changes. All 7 changes occurred in the complex procedures

(20%).

CONCLUSIONS: Collaboration in the form of case presentations at

a weekly surgical conference resulted in changes in the surgical plan of

20% of complex surgeries. The routine review of planned complex spine

surgical procedures by peer collaboration appears to improve surgical

decisions.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2007.07.161

137. Physical Exam Findings Relate to Perceived Disability in Neck

Patients

Donald S. Corenman, MD, DC1, Sarah A. Kelley-Spearing, BA2, David

C. Karli, MD1, Eric L. Strauch, PA-C1, Rebecca D. Glassman, BA2;1Steadman Hawkins Clinic, Vail, CO, USA; 2Steadman Hawkins Research

Foundation, Vail, CO, USA

BACKGROUND CONTEXT: Little research has been done comparing

objective measurements of patients presenting with neck pain and the per-

ceived disability reported by these patients.

PURPOSE: The purpose of this study was to determine if there was a re-

lationship between the Neck Disability Index (NDI) and the parameters of

a standard cervical physical exam.

STUDY DESIGN/SETTING: This was a case study of 97 consecutive

patients presenting with neck pain at a private orthopaedic clinic.