Burr Ridge, IL — The North American Spine Society, the leading multidisciplinary spine organization worldwide, will hold its 23rd Annual Meeting October 14-18 at the Metro Toronto Convention Centre. The program is jam-packed with the latest spine research, including 105 podium presentations, 99 Special Interest Paper Presentations, 11 Special Interest Group discussions and eight symposia.
Symposia topics include a review of the lessons learned from disc arthroplasty, how to apply evidence-based medicine in a spine practice, and an update on biologics and basic research for spinal disorders. In the Special Interest Group presentations, attendees will hear talks on various topics, including methods to minimize wrong level spine surgery, spine care in Iraq and the emergence of internet-based peer-to-peer collaboration in surgical decision making.
The podium presentations are an integral part of the meeting. The following summaries highlight some of the Best Papers, as selected by the NASS Annual Meeting program committee:
Research supports routine use of validated patient-reported questionnaires
Many patients with spine disorders have significant psychological distress, which is often a predictor of poor surgical outcome. Research shows that as a group, spine specialists do a poor job clinically assessing psychological distress. Michael Daubs, MD, and colleagues at the University of Utah, Salt Lake City, performed a prospective, blinded study that included 400 patients who presented to a university spine center and eight spine specialists. Patients completed a Distress Risk Assessment Method (DRAM) questionnaire and then received a physician’s clinical evaluation. As a group, physicians correctly assessed patient’s psychological distress 44% of the time. “Validated PR questionnaires, such as the DRAM, that assess psychological distress should be used routinely,” the authors wrote. “The results of these questionnaires should be one of the factors considered when making operative and nonoperative treatment decisions.”
SPORT trial results
According to anecdotal evidence, patients with degenerative spondylolisthesis and spinal stenosis with predominant leg pain do better after spine surgery than patients with predominant back symptoms. Spine Patient Outcomes Research Trial (SPORT) data show that surgery produced better results than nonsurgical treatment — regardless of pain location. At two years postoperative, patients with predominant leg pain had better results after surgery than did patients with predominant back pain. SPORT is a five-year, multicenter study on the three most common back conditions. This cohort was led by Adam Pearson, MD, Dartmouth College, and his colleagues at the University of California, San Francisco, Nebraska Foundation for Spinal Research, and Washington University. It included 591 patients with degenerative spondylolisthesis and 615 patients with spinal stenosis. The SF-36 Bodily Pain and Physical Function scores, Oswestry Disability Index (ODI) and the Stenosis Bothersomeness Index all improved. Researchers found similar results in patients with spinal stenosis at two years.
In other SPORT findings, researchers found that regardless of listhesis grade, disc height or mobility, operative patients improved more than nonoperative patients. Pearson and colleagues at Rush University Medical Center and the Hospital for Special Surgery, reviewed the radiographs of 222 patients with degenerative spondylolisthesis. They compared changes in outcome measures between listhesis grade (Grade 1 vs. Grade 2), disc height (low vs. normal) and mobility (stable vs. hypermobile). They found that 86% of patients had a Grade 1 listhesis, 78% had normal disc height and 73% were stable. At baseline, symptom severity was similar. At one year, operative patients had similar outcomes across listhesis, disc height and mobility groups. The ODI scores were -23.7 for Grade 1 vs. -23.3 for Grade 2 (P=.90); disc height was -23.5 for normal vs. -21.9 for low (P=.66); mobility was -21.6 for stable vs. -25.2 for hypermobile (P=.30). Surgery yielded the greatest effects in Grade 2 and stable patients.
Lumbar fusion yields substantial benefit for Medicare-age population
Single-level lumbar decompression and instrumented fusion produced good results in patients older than 65 years, according to results of a randomized, nonblinded IDE trial. Steven Glassman, MD, Leatherman Spine Center, Louisville, Ky, and his co-investigators at the University of Minnesota, Hughston Clinic, Brigham and Woman’s Hospital and the Spine Institute, compared clinical outcomes for lumbar fusion in 50 older and 174 younger patients. At two years postoperative, Oswestry Disability Index scores were 28.5 in older patients and 24.5 in younger patients. Patients in the older group had better scores at all time intervals, although only the six-month score reached significance (P=.041). SF-36 PCS scores improved 14.2 points in the older patient group and 11.7 in the younger patient group. Older patients had greater improvement in back pain numeric rating scales at all time intervals.
Diagnostic specificity key element to improve evidence base
Results of a prospective trial underscore the importance of diagnostic specificity in building an improved evidence base for lumbar fusion surgery. Six surgeons at a tertiary spine center collected data on 327 patients. The patients had two-years of follow-up and had been treated with decompression and posterolateral lumbar fusion. Steven Glassman, MD, the Leatherman Spine Center, and colleagues at the Spine Institute, Louisville, Ky, used the SF-36, the ODI and numeric rating scales for back and leg pain. The ODI improved the most in patients with spondylolisthesis and scoliosis. Nonunion patients improved the least. At two years postoperative, 71% of patients with spondylolisthesis reached a minimum clinically important difference (MCID) vs. 34.8% in the nonunion group. The SF-36 PCS improved the most in patients with disc pathology, spondylolisthesis and scoliosis.
Low back pain classification system effective
The findings of a prospective, double-cohort study show that classification-based treatment positively effected outcomes. Greg McIntosh, MSC, and his co-investigators at the Canadian Back Institute, compared outcomes in a conservative care setting between patients treated with and without a diagnostic system of low back pain classification. The comparison group (n=754) included patients receiving treatment at eight clinics that did not use a classification-based system. The classification group (n=1469) included patients at seven clinics that used a low back pain classification system that emphasizes mechanical assessment, pattern of pain recognition and appropriate treatment direction, according to the researchers. Treatment based on the classification system yielded greater pain reduction (P<.001), higher functional improvement (P<.001), less medication use (P<.001) and fewer treatment days (P<.001).
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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 24 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 part of the NASS membership. 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:
Frank Kocich
Toll-free: (866) 960-NASS (6277)
Direct: (630) 230-3648
Fax: (630) 230-3748