109SProceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S

Company List Price) on all 100 patients. Our analysis then multiplied the

post-operative CSF leak rates from the RCT for 100 hypothetical spinal

procedures resulting in expected numbers of CSF leaks of 7 and 11 for

PEG hydrogel sealant and fibrin sealant, respectively. The expected num-

ber of CSF leaks for each group was then multiplied by the cost for CSF

leaks in spinal procedures from the PPD analysis. The expected cost of

CSF leaks in each group was then added to the total treatment costs for

100 spinal procedures in each group.

RESULTS:We found the average cost of spinal surgeries with CSF leaks to

be significantly higher at $25,812 (635,977) compared with $19,333

(622,772) for spinal surgeries without CSF leaks (p!0.0001) corresponding

to an incremental additional cost of $6,479 per CSF leak. The cost difference

was largely due to increased length of hospital (2.6 days), intensive care unit

(ICU, 0.8 days), and pharmacy costs for CSF leaks. The total costs (eg, ex-

pected cost of CSF leaks in each group + treatment costs) for PEG hydrogel

sealant and fibrin sealant for 100 hypothetical spinal procedures were

$103,353 and $94,869, respectively. Therefore, the use of a PEG hydrogel

sealant would cost an additional $85 per patient ($8,484 over 100 patients)

for a hospital that performed 100 spinal procedures using a PEG hydrogel

sealant compared with fibrin sealant on all 100 procedures.

CONCLUSIONS: For a small incremental additional cost per patient, the

use of a PEG hydrogel sealant may provide improved outcomes with re-

spect to post-operative CSF leaks compared to fibrin sealant.

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

any applicable devices or drugs.

doi: 10.1016/j.spinee.2010.07.286

P11. Short Same-Segment Fixation of Thoracolumbar Burst

Fractures

T. Eno Jonathan-James, BS1, James L. Chen, MD2, Morris M. Mitsunaga,

MD3; 1Warren Alpert Medical School of Brown University, Providence, RI,

USA; 2University of Hawaii Orthopaedic Residency Program, Honolulu,

HI, USA; 3The Queen’s Medical Center, Honolulu, HI, USA

BACKGROUND CONTEXT: Minimizing the number of vertebral levels

involved in fusionof a spine fracture is a commongoal of internalfixation. This

is achievable by utilizing traditional short-segment posterior fixation (SSPF).

However, in SSPF there is a reported up to 54% incidence of instrument failure

or unfavorable clinical outcome. Short-segment posterior fixationwith pedicle

fixation at the level of the fracture (short same-segment fixation) suggests bio-

mechanical advantages towardmaintenance of kyphosis correction and reduc-

ing failure rates, however its clinical efficacy is largely unknown.

PURPOSE: The purpose of the study was to explore an alternative treat-

ment of thoracolumbar burst fractures with less long-term morbidity and

a lower failure rate than traditional short-segment posterior fixation.

STUDY DESIGN/SETTING: All patients were surgically treated with

short same-segment fixation in a Level-2 trauma center. Pedicle screws

were placed at one level above and below the fracture site. Additionally,

pedicle screws were also inserted at the level of the fracture.

PATIENT SAMPLE: The study involved 25 one- or two-level thoraco-

lumbar burst fracture patients between September 2005 and April 2009

treated in a Level-2 trauma center.

OUTCOME MEASURES: The primary outcomes of the study were inci-

dence of reoperation and loss of kyphosis correctionwithin the followupperiod.

METHODS: Fourteen male and 11 female patients with an average age of

41.27 years (range 16 to 74 years) comprised the study. Inclusion in the

study required only confirmed thoracolumbar fracture by plain radio-

graphs, computed tomography, and magnetic resonance imaging. Each pa-

tient was treated with short-same segment fixation for thoracolumbar burst

fractures between levels T11 and L4. Fractures were scored based on the

Gaines load-sharing classification, with an average score of 5.96 (range

3 to 8). Patients were also graded preoperatively and postoperatively based

on the Frankel Scale; preoperatively, one grade A, one grade B, nine grade

C, six grade D, and nine grade E patients comprised the study.

All referenced figures and tables will be available at the Annual Mee

RESULTS: Eight percent (2/25) of the patients required reoperation due to

hardware failure or pseudoarthrosis. Average loss of kyphosis correction

(excluding failures) was 10.78�.CONCLUSIONS: Treatment of fractures of the thoracolumbar spine has

been and remains a controversial topic among orthopedic spine surgeons,

and a significant failure rate of traditional SSPF has necessitated explora-

tion of alternative treatment. Our study indicates that short same-segment

fixation has a low failure rate over an average of two years.

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

any applicable devices or drugs.

doi: 10.1016/j.spinee.2010.07.287

P12. Unstable Traumatic Injuries of the Cervicothoracic Junction

Eugene Wong, MD1, Peter Wilde, MD, MBBS, FRACS2; 1Emory

University, Decatur, GA, USA; 2Vertebral Column Surgical Group Austin

Health, Heidelberg, Australia

BACKGROUND CONTEXT: Unstable fractures at the cervicothoracic

junction is a rare injury with a variation of injury patterns and poor neuro-

logical outcome. Diagnosis of these injuries require good imaging and

fixation is biomechanically challenging.

PURPOSE: The aim of this study was to evaluate the surgical experience

in treating traumatic fractures at the cervicothoracic junction.

STUDY DESIGN/SETTING: Retrospective review.

PATIENT SAMPLE: Consecutive patients who underwent surgery for

unstable fractures/dislocation at the cervicothoracic junction from 2006

to 2008.

OUTCOME MEASURES: Clinical and radiological outcomes.

METHODS: There were 11 patients who underwent surgery for unstable

fractures/dislocation at the cervicothoracic junction from 2006 to 2008.

Clinical outcome was evaluated using ASIA scoring and radiological out-

comes using CT scans and plain radiographs. Follow-up periods ranged

from 11 to 48 months, with an average of 18 months.

RESULTS: 9 patients sustained complete neurologic deficits with no re-

covery ASIA Awith the remaining ASIA B. Neurologic deficit was related

to the degree of anterior displacement of C7 on T1. 8 patients sustained

a C7 burst fracture and 3 had a C7 T1 fracture dislocation. Anterior cor-

pectomy and fusion was performed in 8 patients. Posterior reduction and

rod- screw fixation was done in 1 patient while a combined approach

and fixation was performed for 2 patients. There was a complication of

misplaced upper cervical plate screws with tilting of the mesh cage inferi-

orly. No subsequent displacement of the implant was noted on follow-up.

CONCLUSIONS: Fracture-dislocation at the cervicothoracic junction is

a rare injury with a poor neurologic outcome. The anatomic and biome-

chanical features of the cervicothoracic junction require the selection of

suitable approach and implants. The anterior approach is valuable in treat-

ing burst fractures at C7. Facet dislocations at the cervicothoracic junction

are best treated with a posterior lateral mass and pedicle screw fixation or

with a combined approach.

FDA DEVICE/DRUG STATUS: Cervical plate, Titanium cage, Posterior

screws and rods: Approved for this indication.

doi: 10.1016/j.spinee.2010.07.288

P13. Correlation of Vertebral Strength Topography

with Three-Dimensional Computed Tomography Structure

Andriy Noshchenko, MD, Vikas Patel, MA, MD, Evalina Burger, MD;

Colorado University at Denver, Aurora, CO, USA

BACKGROUND CONTEXT: To prevent intervertebral implant subsi-

dence, the interface between the implant and the vertebral bone must have

sufficient strength. Strength across the endplate is not consistent. Accurate

ting and will be included with the post-meeting online content.