Session 16:
Poster med foredrag C
Onsdag 21. oktober
11:00 – 12:00
Lokale: Helsinki / Oslo
Chairmen: Søren Eiskjær / Ole Rahbek
162. Conventional Supine MRI with a Lumbar Pillow an alternative to Weight-Bearing MRI for diagnosing functional spinal stenosis? A Cross-Sectional Study
Bjarke Brandt Hansen, Philip Hansen, Mikael Boesen
The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.
Background: An important aspect of Lumbar Spinal
Stenosis (LSS) is the relationship between
posture and symptoms, which are often
accentuated when standing, walking or with
spinal extension. It is well known that the
dimensions of the spinal canal increases
with flexion and decreases with extension.
Purpose / Aim of Study: To investigate if a lumbar pillow is
comparable to standing weight-bearing MRI
for diagnosing functional LSS
Materials and Methods: Clinical MRI scans were screened for a
single level moderate LSS defined by a
Dural Cross-Sectional Diameter (DCSD)
between 7-10mm. If present, the patient
was asked to participate in this study, where
a second scan in a (0.25T) open G-MRI unit
was performed in: 1) standing 2) the
conventional supine position with a pillow
under the legs and 3) supine position with
extended legs and a lumbar pillow. The L2-
S1 lumbar lordosis angle (LA), Spinal
Cross-Sectional Diameter (SCSD), Dural
Cross-Sectional Diameter (DCSA) and
DCSD were measured in each position.
Findings / Results: Twenty-seven patients (mean age 60.6
years; ±9.4) were included. All had
increasing symptoms while standing or
extending their lumbar spine. The LA
increased significantly when changing from
supine to the standing posture (MD: 3.4;
P<0.001) and with the lumbar pillow (MD:
13.1; P<0.001). One-way ANOVA for
repeated measurements indicated
significant differences between positions
(P<0.001). The following pairwise
comparison showed decreased SCSD,
DCSA and DCSD in both standing weight-
bearing position and with the lumbar pillow
compared to the conventional supine
position (P<0.001). Higher average pain
scores (VAS) were reported during scans
with the lumbar pillow (5.4±2.7) than
standing (4.0±2.7) and the conventional
position (3.6±2.8).
Conclusions: A lumbar pillow may be an inexpensive
method to improve the supine MRI
diagnostics of functional LSS.
163. Rate of unsuspected malignancy in patients with vertebral compression fracture undergoing percutaneous vertebroplasty
Emil Jesper Hansen, Ane Simony, Mikkel Østerheden Andersen, Leah Carreon
Rygkirurgisk sektor, Middelfart Sygehus
Background: Osteoporotic vertebral compression
fractures (VCF) affect approximately 20% of
postmenopausal women and can lead to
long-term disability. Percutaneous
Vertebroplasty (PVP) is a minimally invasive
procedure, primarily used in patients with
severe pain after VCF. Even with a thorough
clinical examination, MRI scans and blood
samples, some fractures maybe caused by
an underlying malignant disease.
Purpose / Aim of Study: To determine the malignancy rate and
histology in bone biopsies obtained during
PVP for VCF.
Materials and Methods: 144 consecutive patients underwent PVP for
painful VCF, at the Center for Spine Surgery
and Research, Middelfart Hospital. All
patients had bone biopsies obtained during
the PVP, and these biopsies were sent to
the Department for Pathology at Vejle
Sygehus for histologic diagnosis.
Findings / Results: 144 patients were included in this study. The
majority of the biopsy specimens (137,
95,1%) were acceptable for histological
diagnosis. 129 (89.6%) of the biopsies
showed no signs of malignancy. Seven (4,9
%) were positive for malignancy. 1 biopsy
was positive for MGUS. Seven (4.9 %) of
the biopsies were unsuitable for histologic
diagnosis.
Conclusions: Our study shows an incidence of
unsuspected malignancy in biopsies
during PVP of 4.9 %. Conservative
treatment with analgesics and brace can
potentially delay diagnosis and treatment
of underlying malignant disease. We
recommend biopsy during PVP as a
standard-procedure, to insure not to
overlook any underlying malignancy
despite the MRI-scan, blood analysis and
clinical examination being inconspicuous.
164. Selective motor branch block of the rectus femoris as diagnostic tool before surgical rectus transfer
Stig Sonne-Holm, Derek Curtis, Hanne Bloch Lauridsen, Billy Kristensen, Jesper Bencke
Dep. of Orthopaedic Surgery & Laboratory of Gait and Human Movement, Hvidovre Hospital; Laboratory of Gait and Human Movement, Hvidovre Hospital; Dep. of Anesthesiology, Hvidovre Hospital
Background: Stiff knee gait is defined as decreased knee flexion in
the swing phase of gait, and may be due to hyper
activity in the rectus femoris (RF), the whole
quadriceps muscle and/or tightening of the muscles,
Surgical RF transfer may not improve gait, if other
factors than the RF is influencing gait.
Purpose / Aim of Study: The purpose was to investigate if pre-surgery
selective motor branch block (SMBB) of the RF may
predict outcome of subsequent RF transfer surgery.
Materials and Methods: Seven patients with hemi- or diplegic cerebral palsy
and with stiff knee gait, age 11-55, 3 males and 4
females were included in the study. Biomechanical
gait analyses (GA) were performed before and after
SMBB using a local anaesthetic. Maximal knee
flexion in swing phase obtained from pre- and post
lidocain GA as well as from a 12 months post-
surgery GA was compared using non-parametric
statistics.
Findings / Results: In one patient the nerve block acted on the entire
femoral nerve, this patient was therefore excluded
from this study. One patient declined surgery due to
a less than 2 degrees improvement by SMBB and
was therefore excluded. The remaining five patients
showed better gait function following the block and at
follow up 12 months after RF transfer surgery. The
range of motion in swing phase increased
significantly from median 32.3 to 38.6 degrees
(p=0.043) after SMBB and 12 months after RF
transfer surgery to 51.3 degrees (p=0.043).
Conclusions: The present study on preliminary data therefore
indicates, that SMBB of the RF may be a feasible
way to predict positive outcome of RF surgical
transfer in patients with stiff knee gait. However,
post-surgery data on patients with negative results of
SMBB would be necessary in order to perform a
proper sensitivity analysis for this new diagnostic
tool. It was not possible in this study for ethical
reasons.
165. TheStaRT Back Sreening can predict pain problems after spine surgery.
Lisbeth Storm, Rikke Rousing, Leah Carreon, Mikkel Østerheden Andersen
Center for spine surgery and research, Middelfart, sygehus lillebælt
Background: Following spine surgery a number of
patients develop complex pain problems.
To prevent these problems, it is
important to identify these patients
before surgery in order to optimize their
postoperative pain management. A
simple and convenient tool is needed to
identify these patients.
Purpose / Aim of Study: To investigate if the STarT Back
Screening Tool can identify patients in
risk of developing complex pain after
spine surgery. This tool separates the
patients into low, medium or high risk of
developing complex chronic pain. STarT
has not been tested on surgical patients.
Materials and Methods: Patients who had a lumbar spine
surgery in our department during a 3-
month period completed the STarT Back
Tool preoperatively. Postoperatively their
back and leg pain were scored on a
visual analogue scale (VAS) day one
after surgery and at discharge. The
score was repeated four or twelve
weeks after surgery. The VAS -scores
preoperatively and at 1-year follow-up
were acquired from DaneSpine
Findings / Results: There were 255 patients (93%) rated by
the STarT Bach Tool. Of these 139
(54%) were in the high risk group, 83
(33%) in the medium risk group, and 33
(13%) in the low risk group.
At discharge patients in the high risk
group had higher back and leg pain
scores compared to the patients in the
medium and low risk groups. This did not
reach statistical significance.
Follow-up data, 4 or 12 weeks
postoperatively from 222 (87%) patients
showed that patients in the high risk
group had statistically significantly
higher back and leg pain scores
compared to the patients in medium and
low risk group. This difference were
also statistically significant at 1-year
follow- up.
Conclusions: The STarT Back Screening Tool can
predict prognoses in short and long
term, but it does not predict pain
problems in the perioperative phase.
166. Arthroscopic evaluation of degenerative changes in the trapeziometacarpal joint
Lone Kirkeby, Lene Dremstrup, Hansen Torben Bæk
University clinic for hand-, hip- and knee surgery, Regional Hospital Holstebro, Aarhus University
Background: Osteoarthritis of the trapeziometacarpal joint
is common in postmenopausal women and
men above the age of 50. Younger patients
may however present clinical symptoms of
osteoarthritis without significant
degenerative signs on radiographs.
Purpose / Aim of Study: To evaluate the effectiveness of arthroscopy
in evaluation of suspected degenerative
changes of the trapeziometacarpal joint in
cases with only minor radiological changes.
Materials and Methods: We retrospectively evaluated the result of
13 arthroscopies of the trapeziometacarpal
joint in 13 patients (2 males and 11 females)
mean age 46 years (range 19-58) with
persistent pain in the trapeziometacarpal
joint at rest and activity but with only minor
or no degenerative findings on radiographs
or CT scan. Post traumatic osteoarthritis
was suspected in 4/13 patients aged 19-51,
and in the remaining 11 patients primary
osteoarthritis was suspected.
Findings / Results: In all patients degenerative changes were
found ranging from cartilage degeneration in
part of the joint to denuded bone at both
sides of the joint. In 9/13 the changes were
so severe, that the patients were treated
with further surgery such as total joint
arthroplasty. In four patients a clear
diagnosis was found, but so far further
surgery has not been performed.
Conclusions: Arthroscopy seems effective in diagnosing
degenerative changes of the
trapeziometacarpal joint in cases with none
or only minor radiological changes but
persistent and significant clinical symptoms
of osteoarthritis.
167. Revison procedures do not affect survival after surgical treatment of acute metastatic spinal cord compression (MSCC).
Maria Ferm Eisenhardt, Søren Schmidt Morgen, Martin Gehrchen, Sidsel Fruergaard, Benny Dahl
Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet and University of Copenhagen
Background: Spinal metastases occur frequently in
patients with oncological conditions and
patients with acute MSCC may benefit from
surgical treatment followed by radiation
therapy. Due to the poor general condition
in the majority of these patients, revision
surgery may result in significant morbidity.
Purpose / Aim of Study: The purpose of the present study was to
assess the impact of revision procedures on
survival in patients undergoing surgical
treatment for acute MSCC.
Hypothesis:
Revision procedures after surgical treatment
of acute MSCC affect survival negatively.
Materials and Methods: Design:
Single-center, prospective, cohort study.
Methods:
All patients undergoing acute surgery for
MSCC in the period January 1st, 2008
through December 31st, 2013 were
prospectively enrolled in a clinical database.
All relevant variables were registered and
survival status per December 31st, 2014
was retrieved through the National Health
Service.
Findings / Results: A total of 556 patients were included in the
six-year study period with a minimum follow-
up of one year. Twelve patients had
emigrated or were non-Danish citizens,
resulting in a 98% data completion
comprising 544 patients in the final study
population. The mean age of the patients
was 64 years and 57% of the patients were
men with no significant difference in survival
between genders. The primary location of
the metastasis was thoracic (55%) and 74%
of patients underwent instrumented
procedures. At least one revision was
carried out in 45 patients corresponding to
an overall revision rate of 9%. There was no
significant difference in survival between
patients undergoing revision and patients
who only underwent one procedure; mean
566 days vs. 489 days (P=0.4).
Conclusions: Revision surgery does not affect survival in
patients operated for acute MSCC
168. Evaluation of cell binding peptide (P15) in silk fibre enhanced hydroxyapatite bone substitute for posterolateral spinal fusion in sheep
Martin Glasdam Axelsen, Stig Mindedahl Jespersen, Søren Overgaard , Ming Ding
Department of Orthopedic Surgery, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark; Department of Orthopedic Surgery, Odense University Hospital
Background: Posterolateral fusion (PLF) is indicated
in the surgical management of various
spinal disorders. To ensure stabile
fusion, bone graft materials are used..
CE approved ABM/p15 (Anorganic Bone
Matrix) has in a previous preclinical
study from our group shown extensive
ability of migration when used in
uninstrumented PLF. In this study, silk
fibers were added to the graft material to
make a mesh for the ABM/p15 granules.
Silk fibers have high biocompatibility and
strength. P15 is a synthetic, 15 amino
acid peptide sequence, with
osteoinductive properties. In this study
we investigate the effect of P15 peptide
when coated on ABM combined with a
silk fiber mesh
Purpose / Aim of Study: Compare fusion rates using silk fibre
enhanced ABM with or without P15 peptide
in uninstrumented PLF
Materials and Methods: Two level uninstrumented PLF at L2/L3 and
L4/L5 were performed in 12 sheep. Levels
were randomised to silk fibre enhanced
ABM bone graft with or without P15 coating
bilaterally. After 4.5 month, levels were
harvested and evaluated with MicroCT 50
scans and qualitative histology. Fusion
rates were assessed with 2D sections and
3D reconstruction images and fusion was
defined as intertransverse bridging
Findings / Results: Spinal fusion was found in 72% of levels
receiving silk fibre enhanced ABM/P15 graft
material and 41% in levels without P15
(P<0.05). No major migration was detected.
Histology indicated more bone formation in
P15 group with laminar initiation. In both
groups good osteointegration was found.
Conclusions: P15 peptide enhanced fusion rates when
coated to ABM in silk fibre enhanced bone
graft. Reported fusion rates are equal to
earlier reported rates using allo- or
autograft. This preclinical study indicates
that silk fibre enhanced ABM/P15 is a
potential graft material for clinical use which
should be evaluated in a controlled clinical
study
169. Revision of total wrist arthroplasty
Michel E. H. Boeckstyns, Guillaume Herzberg
Clinic for Hand Surgery, Gentofte Hospital; Unit for Wrist Surgery, Edouard Heriot Hospital, Lyon University
Background: Third generation implants for total wrist
arthroplasty (TWA) has now been available
for more than 17 years. Consequently, an
increasing number need revision.
Purpose / Aim of Study: To report on our experience with revision
surgery after failed TWA
Materials and Methods: We prospectively and consecutively
collected data on all TWA's that were
revised in two clinics and made a general
follow-up examination in May - June 2015.
Findings / Results: We revised a total of 19 cases: 8 with
rheumatoid arthritis, 11 with other
diagnoses. 12 were revised to a Remotion
TWA, 1 to an Amandys interposition implant
and 6 were fused. At final follow-up, at an
average of 31 months after operation,
median improvement in QuickDASH score
was 25 points, median improvement in VAS-
score for pain was 50 points. 3 revision
TWA had been re-revised and 1 was loose
and scheduled for re-revision.
There was no difference in QuickDASH- or
in VAS-score between patients with fusion
and patients with TWA.
Conclusions: Both fusion and revision to a new TWA are
feasible after a failed TWA. Revision to a
new TWA may require supplementary major
procedures.
170. 3D Correction by CB Growth Rod Concept in Severe Deformities of the Immature Spine (EOS)
Simon Toftgaard Skov, Barbara Jensen, Haisheng Li, Ebbe Stender Hansen, Kristian Høy, Cody E. Bünger
Ortopaedic dep. E, Aarhus University Hospital; Orthopaedic Research Lab., Aarhus University Hospital
Background: Management of severe EOS should ensure
a 3D-correction with preserved pulmonary
function and truncal growth. We have
developed a novel growth rod concept.
Purpose / Aim of Study: Aims of this study were to 1) analyse 3D-
curve-correction and truncal height and 2)
monitor adverse events.
Materials and Methods: 34 patients have been treated with the new
concept based on 4.5 mm pediatric
implants since 2010. We excluded patients
with less than 2 years follow-up (n=13) and
complex salvage procedures (n=2). The
study group of 19 patients has a mean
follow-up of 3.0 years(2.1-3.9), mean age
at index surgery 9.8 years(4-14) and mean
scoliosis Cobb angle 77°(47-129).
Etiologies: neuromuscular(n=9),
idiopathic(n=4), and others(n=6). The
tripple rod system is mounted on pedicle
screws in 3 platforms, cranial, apical and
caudal, using minimal invasive technique.
Deformity correction is achieved by
concave distraction, apical translation and
derotation by applying apical compression.
Lengthening as a one day procedure every
6 months until skeletal maturity by concave
distraction and locking, leaving convex
growth tubes unlocked.
Findings / Results: Index surgery decreased scoliosis Cobb
by median 37°(15-68). Thoracic
hyperkyphosis decreased, without
significant change in lordosis. Torsion was
corrected by 14% with partial loss over
time. Truncal height assessed as T1-S1 on
digital x-rays, increased by 0,9±0.7
cm/year. 16 adverse events in 11 patients.
Six complications lead to unintended
reoperation (32%). Asymptomatic metal
debris (n=6).
Conclusions: Our triple growing rod concept proves 3D-
correction in the surgical management of
severe EOS. Complication rate is 32%.
Further improvement on rotatory control
and prevention of metal debris needed.
171. Risk factors for recurrent lumbar disc herniation
Stina Brogård Andersen, Elisabeth Corydon Smith, Christian Støttrup, Mikkel Andersen
Center for Spine Surgery and Research - Middelfart, Sygehus Lillebælt
Background: The rate of recurrent lumbar disc herniation
(rLDH) following lumbar discectomy varies
from 3-11 % and thereby being the most
common complication. Though many
studies have reported the rate of rLDH, few
have provided statistical evidence of risk
factors. Current literature reports multiple
risk factors, however with diverging
incidence. Overall, the current literature
provides limited certainty regarding risk
factors of rLDH.
Purpose / Aim of Study: The purpose of the present study is to
examine if age, gender, smoking habits and
BMI are risk factors for rLDH.
Materials and Methods: All patients who underwent primary lumbar
discectomy due to LDH at Lillebaelt Hospital
from June 2009 to January 2015 were
included. Self reported data on age, gender,
smoking status and BMI were prospectively
collected in the database DaneSpine. All
statistical analyses were carried out using
STATA version 12.1.
Findings / Results: A total of 1572 patients were included. 124
patients (7,9%) were re-operated; 109
patients (7,0%) due to rLDH. Other reasons
included persisting stenosis, cerebral spinal
fluid fistula, etc.. The mean age was
significantly lower in the rLDH group
(48,3(CI 47,5;49,0) vs. 44,7(CI 42,5;46,9))
(P=0,01). The rate of smokers was
significantly higher in the rLDH group (34%
vs. 53%)(P=0,001). There was no statistical
difference in gender or BMI between the two
groups.
Conclusions: The rate of rLDH in the present study
corresponds to results presented in
previous studies. We found that the mean
age was lower in the rLDH group and that
the rate of smokers was higher. We can
also conclude that the rate of smokers in the
total surgery group was higher than in the
general Danish population. This indicates
that smoking not only increases the risk of
rLDH and there seems to be a higher
prevalence of smokers among patients
undergoing lumbar discectomy.
172. Treatment of Pathologic Acetabular Fractures with Tri-flange Reconstruction Cage
Elinborg S. Mortensen, Peter Horstmann, Michala S. Sørensen, Werner Hettwer, Michael M. Petersen
Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Copenhagen University hospital, Rigshospitalet
Background: Periacetabular reconstruction for
metastatic bone disease (MBD) can be
accomplished with a composite
construct of PMMA and any
combination of metal augments, mesh,
pins, cages and/or plates.
Reinforcement of such constructs by
trans-iliac Steinmann pin fixation
according to the technique described
by Harrington, is typically
recommended for more extensive
lesions involving the acetabulum.
Purpose / Aim of Study: To investigate results when treating
MBD acetabular fractures with tri-
flange reconstruction cages without the
use of trans-iliac Steinmann pin
fixation.
Materials and Methods: We performed a retrospective review
of a consecutive cohort of adult
patients with MBD, who underwent
endoprosthetic reconstruction because
of pathologic acetabular fractures in
our department between January 2008
and September 2014. We identified 18
patients (F/M=11/7) with a mean age
of 70 (49-92) years, who received a
standard, long flanged stainless steel
cage (Link partial pelvis replacement).
Cemented acetabular components
(Lubinus Eccentric) were used in all
patients.
Findings / Results: Seven patients succumbed to their
disease within the first year after
operation (probability of 1-year overall
survival 61%). 4 complications required
second intervention. Two dislocations
were observed within the first year and
were treated with implantation of a
constrained devise. One patient had
revision of wound. One patient
suffered from deep infection and is
currently undergoing 2-stage revision.
All patients but one regained
ambulatory function and we did not
observe any failures of the pelvic
reconstruction constructs.
Conclusions: Our findings suggest that standard tri-
flange pelvic reconstruction cages can
be a valuable treatment option in the
management of pathologic acetabular
fractures.