Joseph Albano, DO, MBA PGY 3 Plainview Hospital, Northwell Health - PowerPoint PPT Presentation

Joseph Albano, DO, MBA PGY 3 Plainview Hospital, Northwell Health

Disclosures  No Disclosures

Background  Most spine surgery performed without preoperative pedicle measurements  Some literature looking at individual races 1,2,3,4  Unclear in literature whether inter-race differences exist  Economic Impact 5  Pseudoarthrosis - $76,695  Instrumentation Failure - $66,838  Revision Spine Surgery - $26,592 - $86,673 Tse MS, Chan CH, Wong KK, Wong WC. Quantitative Anatomy of C7 Vertebra in Southern Chinese for Insertion of Lateral Mass Screws and Pedicle Screws. Asian Spine J. 2016 Aug;10(4):705-10. 1 Yusof MI, Ming LK, Abdullah MS, Yusof AH. Computerized tomographic measurement of the cervical pedicles diameter in a Malaysian population and the feasibility for transpedicular fixation. Spine (Phila Pa 1976). 2006 Apr 15;31(8). 2 Christodoulou AG, Apostolou T, Ploumis A, Terzidis I, Hantzokos I, Pournaras. J. Pedicle dimensions of the thoracic and lumbar vertebrae in the Greek population. Clin Anat. 2005 Sep;18(6):404-8. 4 Singel TC, Patel MM, Gohil DV. A study of width and height of lumbar pedicles in Saurashtra Region. J. Anat. Soc. India. 53 (1) 4-9 (2004). 4 Yeramaneni S, Robinson C, Hostin R. Impact of spine surgery complications on costs associated with management of adult spinal deformity. Current Reviews in Musculoskeletal Medicine . 5

Exclusion Criteria Inclusion Criteria  Previous lumbar  CT Abdomen and Pelvis laminectomy  July 1-July 14 2016  Previous instrumented  Must have race and age spinal fusion listed in GE PACS  CT Lumbar Spine  Incomplete Visualization of Pedicles  Transitional Vertebra

 Retrospective review CT Abdomen/Pelvis  506 patients  5060 Pedicles

Strengths Limitations  Large, multicenter study  Patient position/cut size not standardized  Large sample size  Race not confirmed by  Diverse native population genetics  Single observer confirmed  ‘Other’ category not better by senior surgeon defined  No spine related pathology

Conclusions  Smallest pedicle diameters in Asian Race  Largest variability among the Black race  Careful preoperative measurements necessary  Standard Perioperative Xray not adequate to maximize success

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