Burr Ridge, Ill. – November 7, 2007 – This year’s Annual Meeting in Austin, Texas, brought more than 7,700 participants to the Austin Convention Center! Registered attendees accounted for more than half of the overall count, totaling more than 3,800 participants; exhibitor representatives made up more than 3,800 participants as well. The Annual Meeting offered a large variety of symposia, paper presentations, hands-on and didactic courses. The exhibit hall had representation from more than 230 medical technology companies in the spine industry.
The Specialty Education Tracks for non-physicians that were introduced this year targeted nurses, rehabilitation specialists and nurse practitioners/physicians assistants. NASS takes pride in being a multidisciplinary organization and strives to consistently provide more options for all spine care professionals at NASS events. The tracks were well-received and some participants noted that they found a home within the spine care community in NASS.
The paper presentations were an exciting part of the Annual Meeting. Papers covered cutting-edge spine research that was presented for the first time at the Meeting. The following paper summaries highlight some of the Best Papers from the Annual Meeting:
Lumbar spine fusion may not lead to adjacent-level hypermobility
Surgeons continue to debate whether segmental lumbar fusion leads to adjacent segment hypermobility and degeneration. A Swedish study determined that hypermobility was not a typical finding after fusion. Björn Strömqvist, MD, PhD, Lund, Sweden, and colleagues studied the mobility of segments adjacent to lumbar fusion pre- and postoperatively in nine patients with painful degenerative disc disease. All patients failed conservative treatment and were scheduled for segmental lumbar fusion. The researchers performed radiostereometry preoperatively and at the five-year follow-up. At five years, mean transverse, vertical and sagittal translation of the juxta-fused vertebrae was unchanged from the preoperative measurements. A relative mobility increase was not associated with adjacent segment degeneration or a poor clinical outcome.
CRP high after spinal instrumentation although no infection present
Diagnosing and treating surgical site infections (SSI) early, especially in spinal instrumentation, is critical to avoiding major complications. When the markers of SSI remain high after surgery — C-reactive protein, white blood cell count and body temperature — surgeons must consider infection as the cause. Masao Deguchi, MD, of Nagano Red Cross Hospital in Japan, however, found that C-reactive protein levels remain high for at least two weeks following spinal instrumentation surgery without evidence of infection. His study included 1,057 patients undergoing spinal decompression with or without instrumentation from 1997 to 2006. Based on his results, Deguchi defined the normal upper limit for C-reactive protein at two weeks as no more than 3.6 mg/dL. The white blood cell count at two weeks should be no more than 9,900. A body temperature of 37.7 degrees Celsius is normal at two weeks, the researchers found.
Maverick Disc superior to ALIF in IDE trial
The Maverick Disc resulted in improved physical function, reduced pain and an earlier return to work compared to anterior lumbar interbody fusion, according to results of a prospective, randomized, multicenter controlled IDE trial. Matthew F. Gornet, MD, of The Orthopedic Center of St. Louis, reported that at two years, total disc replacement (TDR) patients had better Oswestry Disability Index, SF-26 PCS and back pain scores. TDR patients returned to work 21 days sooner in median than ALIF patients. In addition, TDR patients had better satisfaction scores, with 86.2% indicating they would have the surgery again vs. 74.5% in the ALIF group. “A randomized trial with this modern fusion technology as a control ensured the most rigorous study comparisons, validating the benefits of the Maverick disc for appropriately selected patients,” Gornet wrote.
Scoliosis incidence low in adults
The reported prevalence of adult scoliosis ranges considerably from 1.9% to 68%, depending on the definition of scoliosis used and the patient population studied. A recent study found that the prevalence of lumbar scoliosis was 8.85% in a population of adults aged 40 years and older. The study was conducted by Khaled Kebaish, MD, FRCS(C), Department of Orthopedics, The Johns Hopkins University, and colleagues. It included 2,973 people, aged 40 years and older who had dual energy X-ray absorptiometry scans between January 2004 and March 2006 at a university hospital. The researchers used Cobb’s method to diagnose scoliosis, which they defined as a curvature of at least 11°. Kebaish and colleagues found that getting older was associated with increased scoliosis prevalence. African-Americans had a reduced scoliosis risk. The researchers found no link between gender and scoliosis risk.
Gene linked to cause of OPLL
The nucleotide pyrophosphatase (NPPS) gene is critical in the etiology of human ossification of the posterior longitudinal ligament (OPLL) of the spine, according to Isao Nakamura, Shinsu University, and colleagues. The researchers analyzed data from 323 patients with OPLL and 332 controls. Using DNA samples extracted from peripheral leukocytes, Nakamura and colleagues identified 10 nucleotide variations in the NPPS gene. Five mutations caused amino-acid substitutions; the researchers found two of these in OPLL patients. “We performed an association study using these variations and found a significant association of an allele, viz. a deletion of T at a position 11 nucleotides upstream from the splice acceptor site of intron 20 (IVS20-11delT), with OPLL,” the researchers wrote. More OPLL patients had this deletion than controls. The patients with the variation IVS20-11delT are more vulnerable to abnormal spinal ligament ossification, Nakamura wrote. “Thus, our study suggests that NPPS plays an important role in the etiology of human OPLL.”
No evidence of hypersensitivity with repeat use of rhBMP-2
Repeated use of rhBMP-2 in the spine appeared to be safe and efficacious, according to results of a retrospective, consecutive case series. Timothy R. Kuklo, MD, JD, Washington University, followed 92 patients with a minimum two years’ follow-up after thoracic or lumbar fusion with repeat use of rhBMP-2. According to Kuklo and colleagues, rhBMP-2 appeared to be safe regardless when the second dose was given, total dose or concentration. They did not find evidence of a hypersensitivity reaction or other adverse response.
The NASS 22nd Annual Meeting was a great success and we hope to continue to reach new heights at NASS’ 23rd Annual Meeting, October 14-18, 2008, in Toronto, Canada.
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The North American Spine Society (NASS) grew out of the need for a scientific spine society that would include all members of the spine community regardless of specialty or locale. NASS is a multidisciplinary organization that advances quality spine care through education, research and advocacy. NASS members are MDs, DOs and PhDs in 22 spine-related specialties including orthopedics, neurosurgery, physiatry, pain management and other disciplines. Nurse practitioners, physician’s assistants, chiropractors, physical therapists, practice administrators and other allied health care professionals involved in spine care are also represented in NASS as affiliate members. For more information on spine care or to find a spine specialist in your area, please contact 866.960.NASS (6277) or visit www.spine.org.
For further information, contact:
Jean-Marie O'Neal
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