BURR RIDGE, Ill. — The North American Spine Society (NASS), a multidisciplinary organization dedicated to advancing the highest quality, evidence-based and ethical spine care, invites spine specialists from around the globe to attend the 24th Annual Meeting in San Francisco, Nov. 10-14, 2009 at the Moscone Center South. More than 2500 expected attendees will have an opportunity to explore the hottest news in spine education, research and innovation.

This year’s program offers an education experience that will provide many professional challenges and rewards. The program features 179 e-posters; 94 focused paper presentations; eight symposia led by world-renowned spine experts; eight pre-meeting workshops, including technique workshops, led by distinguished faculty; eight dynamic Special Interest Group discussions; and sessions for allied health professionals.

The program also includes 119 podium presentations. The following are summaries of the top five papers, as selected by the NASS program committee. 

Surgery a good option for CSM
The paucity of valid outcomes data on surgical intervention in cervical spondylotic myelopathy (CSM), prompted Michael Fehlings, MD, PhD, FRCSC, FRCS, Toronto, Ontario, and colleagues to perform a multicenter, prospective cohort study on the topic. The non-randomized study included 301 patients with clinically symptomatic CSM treated at 13 North American sites. All patients underwent anterior or posterior decompression/reconstruction. Fehlings and colleagues assessed outcomes with the mJOA, Nurick, SF-36, Neck Disability Index and 30-meter walk test. All patients completed one-year of follow-up, and 65 patients have reached two years’ follow-up. Modified JOA scores, average Nurick scores, the SF-36 MCS scores and the 30-meter walk test scores all improved from baseline to one-year follow-up. The findings demonstrate that surgery is an effective option for patients with symptomatic CSM.

OPLL complicates spinal cord injury
In a retrospective, multicenter study, Hirotaka Chikuda, MD, PhD, Tokyo, Japan, and colleagues studied the clinical characteristics of cervical spine cord injury (SCI) associated with ossification of the longitudinal ligament (OPLL). The study included 453 patients with acute traumatic cervical SCI admitted to one of 34 institutions across Japan with 48 hours of injury. To measure outcomes, Chikuda and colleagues defined neurological improvement as one grade conversion in Frankel grade. The results showed an alarmingly high prevalence of OPLL — 34% — in SCI without bone injury. Low-energy trauma caused most of the SCIs with OPLL. Almost half of the patients (45%) reported a pre-existing gait disturbance. In patients with a pre-existing gait disturbance or those with severe canal compromise, the researchers found that surgery produced better neurological recovery compared with conservative treatment.

Postop dysphagia due to surgery not intubation
Although dysphagia is common after anterior cervical decompression and fusion (ACDF), few prospective studies have examined its severity and incidence. Jeffrey A. Rihn, MD, and colleagues at Thomas Jefferson University, Philadelphia, did just that in their prospective study, comparing results to a control group undergoing lumbar decompression. The 94 participants completed a dysphagia questionnaire preoperatively, and at two, six and 12 weeks postoperatively. The two groups had statistically significant differences in dysphagia at two and six weeks; at 12 weeks, there was a trend toward increased dysphagia in the cervical group. At two weeks, 21.1% of cervical patients reported severe dysphagia and 39.5% reported moderate dysphagia. In the lumbar group, 1.8% of patients reported severe dysphagia and 8.9% reported moderate dysphagia (P<0.0001). Dysphagia incidence and severity decreases over time, although patients may have symptoms for at least 12 weeks postoperatively. The large differences in dysphagia rates noted between the two groups suggest that the anterior cervical surgery rather than the endotracheal intubation causes postoperative dysphagia.

Allograft shape does not improve outcomes
Alan Villavicencio, MD, and colleagues at Boulder Neurosurgical Associates in Colorado, performed a prospective, double blind, randomized clinical study on 122 patients who underwent single and multilevel anterior cervical decompression and fusion (ACDF). Their primary goal was to quantitatively assess and correlate sagittal alignment with clinical outcomes when lordotic or parallel allografts were used. The mean postoperative cervical sagittal alignment was 18.6 degrees in the lordotic group; it was 18.2 degrees in the parallel group. Mean segmental sagittal alignment was 5.9 degrees in the lordotic group and 6.5 degrees in the parallel group. Neither the SF-36 PCS, Neck Disability Index, nor the Visual Analog Scale yielded statistically significant differences between the two groups. Lordotically shaped allografts did not increase cervical/segmental sagittal alignment or improve clinical outcomes. The researchers found that maintaining a consistent segmental sagittal alignment or increasing segmental lordosis improved clinical outcomes.

Balloon kyphoplasty improved quality of life
An international, multicenter, randomized controlled clinical study, the Fracture Reduction Evaluation (FREE) trial, compared the effectiveness and safety of balloon kyphoplasty to non-surgical management for treating acute, painful vertebral body compression fractures. Led by Douglas Wardlaw, MD, Aberdeen, United Kingdom, the study included 300 patients at 21 sites in eight countries. Surgeons performed a percutaneous, bilateral approach on the balloon kyphoplasty patients; nonsurgical treatment was based on the standard practices of each participating hospital. At one month, the mean SF-36 physical component summary score (PCS) improved 5.1 points more in the kyphoplasty group vs. the nonsurgical group. For the kyphoplasty patients, the PCS score improved by an average of 3 points more during the two-year follow-up. Kyphoplasty patients reported statistically significant improvements in quality of life. The surgical procedure also resulted in more pain relief, less Roland-Morris back disability and fewer days of limited activity. In addition, the procedure did not increase adverse events, including vertebral fracture risk over two years.

About NASS
The North American Spine Society (NASS) is a multidisciplinary medical organization dedicated to fostering the highest quality, evidence‐based, and ethical spine care by promoting education, research, and advocacy. NASS is comprised of more than 5,000 members from several disciplines including orthopedic surgery, neurosurgery, physiatry, neurology, radiology, anesthesiology, research, physical therapy and other spine care professionals.  For more information on spine care or to find a spine specialist in your area, please contact 1-877-SPINE-DR or visit www.spine.org.

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