134S Proceedings of the NASS 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S

P71. Hemivertebra Resection Via Posterior Approach In Children

Under Age of Five Years with More than Five-Years Follow-Up

Sinan Kahraman, MD1, Meric Enercan, MD1, Cagatay Ozturk, MD1,

Gurkan Gumussuyu, MD1, Wael Alkasem, MD1, Azmi Hamzaoglu, MD2;1Istanbul Spine Center, Istanbul, Turkey; 2Istanbul, Turkey

PURPOSE: In this retrospective study, we evaluated the radiological and

clinical outcomes of patients under age of five years having posterior re-

section of hemivertebra and pedicle screw to correct and stabilize the

deformity.

STUDY DESIGN/SETTING: Retrospective, Level 4.

PATIENT SAMPLE: Fifteen patients between age 2 and 5 years having

posterior hemivertebrectomy and transpedicular fixation for congenital de-

formities who had more than five years follow-up were reviewed.

METHODS: The surgical technique includes posterior resection of hemi-

vertebra with upper and lower disc spaces followed by short segment in-

strumentation. Compression is applied on the convex side. After gaining

sufficient correction, gap is filled with titanium mesh cage. After surgery,

patients were immobilized in a hip spica cast for 6 months and in a brace

for 6 months more. Radiological and clinical charts were evaluated in

terms of correction in coronal and sagittal plane deformity, balance and

complications.

RESULTS: Mean follow-up was 6.7 years (range; 5 to 11). Average age of

patients (5 male and 10 female) was 3.1 years (2-5). Fifteen patients had 18

hemivertebra levels. Two hemivertebrae were ipsilateral consequent (2 pa-

tients) and two were distant from each other in one patient. Ten levels were

scoliotic deformities with 33� (range: 23-47),8 levels were kyphoscoliotic

deformities [mean scoliosis 29.4� (range: 21-41)],[kyphosis 30.3� (7–

56)].In 3 patients, two-level hemivertebra were present. Nine hemivertebrae

were located in thoracic spine (T3-T11), 3 in thoracolumbar spine (T12-L1)

and 6 in lumbar spine (L2-L5). There was no statistical difference between

early postoperative and last follow-up coronal and sagittal plane deformities.

The coronal plane deformity improved to 3.8� (88%) and was 4.6� at final

follow-up in scoliotic levels. The coronal and sagittal plane deformities were

found 2.7� (91%) and 2.8� (91%) respectively in kyphoscoliotic levels. They

were 3.5� and 3.6� at final follow-up. No adding-on deformity was seen

at final follow-up. Pseudoarthrosis or implant failure was not detected.

CONCLUSIONS: Hemivertebra resection via posterior approach and

short segment transpedicular instrumentation is safe and effective in chil-

dren under age of five years with more than five years follow-up.

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

any applicable devices or drugs.

http://dx.doi.org/10.1016/j.spinee.2013.07.345

P72. Does the Thoracolumbar Upper Instrumented Vertebra (UIV)

Level Make a Difference in Proximal Junctional Kyphosis (PJK)

with Circumferential Minimally Invasive Surgical (CMIS)

Correction of Adult Spinal Deformity (ASD)?

Neel Anand, MD1, Babak Khandehroo, MD2, Keyi Yu, MD3,

Sheila Kahwaty, PA-C1, Eli M. Baron, MD4; 1Cedars-Sinai Medical Center

Spine Center, Los Angeles, CA, US; 2Cedars-Sinai Medical Center, Los

Angeles, CA, US; 3Peking Union Medical College Hospital (PUMCH),

Beijing, China; 4Cedars-Sinai Institute for Spinal Disorders, Los Angeles,

CA, US

BACKGROUND CONTEXT: When instrumenting to the TL junction,

T10 is recommended as the UIV level to prevent junctional problems in

open surgery for adult scoliosis. But to our knowledge, there is no study

that addresses the difference in UIV levels using MIS technique. The pur-

pose of this retrospective study was to determine the PJK incidence and

any differences dependent on the UIV level with CMIS correction of throa-

columbar ASD.

METHODS: A retrospective study of 176 patients who underwent CMIS

correction for their thoracolumbar ASD identified 84 patients with 3 or

Refer to onsite Annual Meeting presentations and postmeeting proceedings for po

reporting disclosures and FDA device/drug

more levels fused. The patients were divided into 3 groups based on the

UIV level. UIV at T10 (group 1, n521),UIV at T11-T12 (group 2,

n520),and UIV at L1-L2 (group 3, n541).A clinical and radiographic as-

sessment was done with a minimum 12-month follow-up (mean 39.5

months follow-up) and compared between the groups. The average age

was 65 years with an average of 6 vertebrae fused. Proximal Junctional

Kyphosis (PJK) was defined as 10 degree increase in Proximal Junctional

Angle (PJA) as measured from UIV/ UIVþ2level.

RESULTS: The incidence of PJK in our whole series was 2.3% (4 of 176

patients) and in our study (when UIV level stops at T10-L2) was 4.7% (4

of 84 patients). In the first patient, the fusion levels were L1-S1; the preop

PJAwas 8.14o and increased to 28.9o at 5 months postop. This patient un-

derwent kyphoplasty with MIS extension of posterior instrumentation 3

levels cephalad. In the second patient, the fusion levels were L1-S1, the

angle increased from 0.62o to 17.83o at 15 months postop secondary to

a compression fracture of the supra-adjacent vertebra and it was corrected

by kyphoplasty. Last follow-up shows both patients were asymptomatic. In

the 3rd patient, the fusion levels were T12-L5; the preop angle was 10o

and increased to 26.54o at 24 months postop. This patient has been sched-

uled for kyphoplasty and posterior reinstrumentation. In the 4th patient, the

fusion levels were L2-S1; the preop angle increased from 1.69o to 13.73o

at 28 months postop. Although theoretically this patient was placed in PJK

group, she has been asymptomatic and declined any revision. The three

groups demonstrated nonsignificant differences in the prevalence of PJK

(pO0.01) at the ultimate follow-up. The SRS total and all subscale out-

comes scores among the 3 groups did not demonstrate significant differ-

ences (PO0.01).

CONCLUSIONS: In our study the incidence of PJK was 4.7%. This is

considerably less than PJK rate of 26-46% quoted regarding surgery for

adult deformity. Our data would suggest that it may not be necessary for

the UIV to be T10 for all thoracolumbar deformities. The UIV level at

a neutral and stable vertebra with normal disc appearance at MRI may

be satisfactory.

FDA DEVICE/DRUG STATUS: RhBMP2 (infuse) (Not approved for this

indication), Multilevel lateral transpsoas interbody Peek device, (Metronic

clydesdale) (Not approved for this indication).

http://dx.doi.org/10.1016/j.spinee.2013.07.346

P73. Fusion Rate of Stand Alone Anterior Lumbar Interbody Fusion

with Recombinant Human Bone Morphogenetic Protein-2 for the

Treatment of Degenerative Disc Disease With and Without

Spondylolisthesis

Eyal Behrbalk, MD1, Bronek M. Boszczyk, MD2; 1Nottingham, UK; 2The

Centre for Spinal Studies and Surgery, Nottingham, UK

BACKGROUND CONTEXT: Anterior Lumbar Interbody Fusion (ALIF)

surgery in combination with posterior fusion is frequently used to treat

structural instability in the setting of symptomatic degenerative disk dis-

ease (DDD). Stand-alone anterior lumbar interbody fusion (ALIF) offers

many advantages over combined anterior and posterior fusion, however

may increase the risk of non-union. The recently introduced intervertebral

devices made of composite material and the use of osteoinductive growth

factors such as recombinant human bone morphogenetic protein-2 (BMP-

2) have been shown to enhance fusion rate in stand-alone ALIF

procedures.

PURPOSE: The objective of this study was to assess fusion rate following

stand-alone ALIF, using the SynFix-LR interbody cage (Synthes Inc, West

Chester, PA, USA) with BMP-2, for the treatment of DDD with and with-

out degenerative spondylolisthesis.

STUDY DESIGN/SETTING: Prospective non randomized study.

PATIENT SAMPLE: 32 ALIF Procedures.

METHODS: Thirty-two ALIF procedures were performed in 25 patients

(72% females, mean age 52614years) between December 2008 and De-

cember 2011. Twenty-five procedures were performed for symptomatic

ssible referenced figures and tables. Authors are responsible for accurately

status at time of abstract submission.