Abstracts of the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves Annual Meeting

2018 Neurosurgical Focus  
Elderly patients, often presenting with multiple medical comorbidities, are touted to be at an increased risk of postoperative complications. As such, we describe our perioperative outcomes in this cohort of patients over the age of 70 following standalone LLIF. Methods: A retrospective query of a prospectively maintained database was performed for patients over the age of 70 who underwent standalone LLIF. The preoperative and postoperative values for the Oswetry Disability Index (ODI) were
more » ... yzed to compare outcomes after intervention. Femoral neck t-scores of the study cohort were acquired from the bone density scans and correlated with the incidence of graft subsidence. Statistical analysis using t-test was performed with IBM SPSS Statistics (IBM, Armonk, NY). Results: Among the study cohort of 54 patients, the median age at the time of surgery was 74 years (range, 70-87 years). Seventeen patients had at least 3 medical comorbidities at surgery. Twenty-two patients underwent a one level, and 32 patients had 2 or more level fusions. The median length of hospital stay was 2 days (range, 1-4 days). No statistically significant relationship was observed between the length of hospital stay and age at the time of surgery. There was one intraoperative death secondary to cardiac arrest, with a mortality rate of 1.9%. One patient developed a transient femoral nerve injury. Five patients with radiographic graft subsidence subsequently required posterior instrumentation. A lower femoral neck t-score < -1.0 correlated with a higher chance of graft subsidence (p=0.006). The mean ODI 1 year postoperatively of 31.1 was significantly (p = 0.003) less than the mean preoperative ODI of 46.2. Conclusion: Standalone LLIF can be safely and effectively performed in the elderly population. Despite an association with increased comorbidities, age alone should not be a deterrent when considering an LLIF procedure in the elderly population. Introduction: Spinal cord injury (SCI) affects significant societal and personal impact which scales with ascending level of injury. Recovery of upper extremity function is the top priority in the tetraplegic SCI population1. We investigate the combined effects of two neuromodulation strategies: transcutaneous electrical stimulation (TES) and buspirone pharmacological modulation, for promoting upper limb motor recovery in chronic cervical SCI tetraplegic subjects. Methods: A double-blind study protocol was used to determine the effects of cervical electrical stimulation alone or in combination with the monoaminergic agonist buspirone on upper limb motor function in subjects with chronic motor complete (ASIA B) cervical injury (n=6). Voluntary upper limb function was evaluated through measures of controlled hand contraction, handgrip force production, dexterity measures, and validated clinical assessment batteries. Subjects underwent pre-intervention assessment followed by three treatment phases with TES and buspirone or placebo. A delayed post-treatment testing period was used to assess for durable improvement in function. Results: All subjects demonstrated improvement in hand strength and upper extremity functional metrics. Mean hand strength increased greater than 300% after transcutaneous electrical stimulation plus buspirone. A corresponding improvement was observed in upper extremity functional metrics. Functional improvements generally persisted after the study interventions were discontinued. Conclusion: We demonstrate that, with these novel interventions, the cervical spinal circuitry can be neuromodulated to improve volitional control of hand function in tetraplegic subjects.
doi:10.3171/2018.3.foc-aspnabstracts pmid:29517273 fatcat:yyrittpuifdmxlmelipbcvmjry