P13. Mini-Open Thoracoscopically Assisted thoracotomy versus Video Assisted Thoracoscopic Surgery for anterior release in thoracic scoliosis and kyphosis—comparison of operative and radiographic results

P13. Mini-Open Thoracoscopically Assisted thoracotomy versus Video Assisted Thoracoscopic Surgery for anterior release in thoracic scoliosis and kyphosis—comparison of operative and radiographic results

Proceedings of the NASS 19th Annual Meeting / The Spine Journal 4 (2004) 3S–119S 89S Table 1 Stiffness (N/m) Group Cavity Creation Osteoplasty Ver...

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Proceedings of the NASS 19th Annual Meeting / The Spine Journal 4 (2004) 3S–119S

89S

Table 1 Stiffness (N/m) Group Cavity Creation

Osteoplasty

Vertebroplasty

T TL L T TL L T TL L

Strength (N)

Height (m)

Initial

Treated

Initial

Treated

Initial

Fractured

Treated

1656 2630 3548 1991 2398 1672 2371 1108 2134

3386 1185 1572 1385 1519 1071 3114 2173 1281

5717 4539 5206 5230 5160 4994 4232 5767 5782

9464 7352 7989 8543 6920 5875 9360 8564 7455

2.29 2.49 3.17 2.46 2.83 3.1 2.28 2.61 3.13

1.66 2.14 2.37 1.64 2.05 2.28 1.59 1.99 2.23

1.89 2.2 2.53 1.85 2.25 2.43 1.8 2.13 2.3

strength and stiffness were measured. Cement leakage was deemed significant if more than 1 mL was seen in the spinal canal, endplate or periphery. RESULTS: Strength was not significantly different among the techniques. T6-T9 was significantly stronger post-fixation versus initially (p⬍0.001). There was a significant difference in height measurements between initial, fractured, and post-fixation for all levels, thoracic p⬍.001, thoraco-lumbar p⬍0.004, and lumbar p⬍.001. No significant difference was found between techniques. Stiffness was significantly different in the lumbar levels between initial and post-fixation measurements p⬍0.02. There was no significant difference in stiffness at other levels or between fixation techniques. Cement extrusion was noted at L4 of the vertebroplasty group. A 1 mL leak was noted in the anterior periphery. T11 for vertebroplasty and T7 of osteoplasty peripherally leaked ⬍0.1 mL and 0.8 mL, respectively. CONCLUSIONS: Strength was not significantly different between the three techniques. The thoracic level (T6–T9) was significantly stronger post-fixation versus initially (p⬍0.001). There was a significant difference in height measurements between initial, fractured, and post-fixation for all levels, thoracic p⬍.001, thoraco-lumbar p⬍0.004, and lumbar p⬍.001. No significant difference was found between techniques. Stiffness was significantly different in the lumbar levels between initial and post-fixation measurements p⬍0.02. There was no significant difference in stiffness at other levels or between fixation techniques. Cement extrusion was noted at L4 of the vertebroplasty group. A 1 mL leak was noted in the anterior periphery. T11 for vertebroplasty and T7 of osteoplasty peripherally leaked ⬍0.1 mL and 0.8 mL, respectively. DISCLOSURES: Device or drug: Methylmethacrylate. Status: Not approved for this indication. CONFLICT OF INTEREST: Authors (HM, JG) Grant Research Support: Funding and equipment supplied by Synthes Spine and Interpore Corporation.

STUDY DESIGN/SETTING: A retrospective review of 45 patients who underwent MOTA or VATS for anterior release, discectomy, and fusion prior to posterior instrumented fusion at one acedemic institution. PATIENT SAMPLE: Twenty-one (13 females, 8 males) consecutive patients who underwent MOTA and 24 consecutive patients (17 females, 7 males) who underwent VATS. The indications included rigid and severe scoliosis or thoracic kyphosis. OUTCOME MEASURES: The patients were compared in terms of correction, number of levels operated, blood loss, and operative time. METHODS: All postoperative data was collected and reviewed. A twosample t-test was used in statistical analysis (p⬍0.05). CONCLUSIONS: As hypothesized, no differences were found in terms of correction and blood loss. We found significant differences in the number of levels operated, favoring VATS, and the overall operative time, favoring MOTA. Both approaches resulted in corrections which compare favorably with open thoracotomy. We suggest that one factor in choosing between these two minimally invasive techniques is the number of thoracic levels requiring release. For four levels or less, MOTA offers a faster and simpler operation. For five or more levels, the added complexity of VATS is justified by an incremental decrease in operative time and blood loss with each additional level. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No Conflicts.

doi: 10.1016/j.spinee.2004.05.179

BACKGROUND CONTEXT: There is a lack of information on national prescription patterns of NSAIDs and muscle relaxants among individuals with back pain in the US. PURPOSE: To examine national prescription patterns of non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants among individuals with back pain in the United States. STUDY DESIGN/SETTING: Secondary analysis of the 2000 Medical Expenditure Panel Survey (MEPS). PATIENT SAMPLE: A nationally representative sample of American adults with back pain in 2000. OUTCOME MEASURES: Prescription of traditional NSAIDs, COX-2 inhibitors or muscle relaxants. It was defined as a dichotomous variable and measured whether or not an individual with back pain had at least one prescription of a drug of interest during the year. METHODS: Individuals with back pain were stratified by socio-demographic characteristics and geographical regions. For each medication category, overall prescribing frequency was compared across different strata and individual drug prescription was analyzed. RESULTS: Traditional NSAIDs, COX-2 inhibitors and muscle relaxants respectively accounted for 16.3%, 10% and 18.5% of total prescriptions for

P13. Mini-Open Thoracoscopically Assisted thoracotomy versus Video Assisted Thoracoscopic Surgery for anterior release in thoracic scoliosis and kyphosis—comparison of operative and radiographic results Rafael Levin1, David Matusz,2*, Amir Hasharoni1, Baron Lonner1, Thomas Errico1; 1New York University, New York, NY, USA; 2Lenox Hill Hospital, New York, NY, USA BACKGROUND CONTEXT: Combining anterior releases, discectomies, and interbody fusion with posterior instrumented fusion is the accepted treatment for severe rigid scoliosis or kyphosis. Video Assisted Thoracoscopic Surgery (VATS) and Mini-Open Thoracoscopically Assisted thoracotomy (MOTA) are two minimally invasive approaches to the thoracic spine. Both reduce surgical trauma, improve cosmesis, and provide effective exposure for release and fusion. PURPOSE: This study compared MOTA and VATS under the hypothesis that both result in similar corrections and comparable operative parameters when used in conjunction with posterior instrumented fusion.

doi: 10.1016/j.spinee.2004.05.180 P103. Prescription of nonsteroidal antiinflammatory drugs and muscle relaxants for back pain in the United States Xuemei Luo1, Ricardo Pietrobon2, Lesley Curtis3, Lloyd Hey, MD1; 1 Duke University Medical Center, Durham, NC, USA; 2Duke University Medical Center, NC, USA; 3Duke University, NC, USA