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North American Spine Society, Oct. 24-27, 2012

The North American Spine Society 27th Annual Meeting

The annual meeting of the North American Spine Society was held from Oct. 24 to 27 in Dallas and attracted approximately 5,000 participants from around the world, including orthopedic surgery, neurosurgery, neurology, radiology, and anesthesiology specialists as well as researchers, physical therapy specialists, and other spine care professionals. The conference featured presentations focusing on the latest advances in medical and surgical spine care.

In one study, Kirkham Burwick Wood, M.D., of the Massachusetts General Hospital in Boston, and colleagues evaluated patients with burst fractures over a 15- to 20-year period to determine whether outcomes were any better with operation versus non-operation.

"We found that patients who underwent surgery for burst fractures experienced no major difference in outcomes as compared to patients who did not undergo surgery for the condition. In addition, over the 15- to 20-year period, we found that patient-related outcomes were actually better in patients who did not undergo surgery," Wood said. "In cases of patients with burst fractures whose ligaments were intact as well as being neurologically intact, outcomes were not much improved with surgery over a 15- to 20-year period."

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In another study, Samuel Bederman, M.D., Ph.D., of the University of California in Irvine, and colleagues found that patients with acute spinal fractures and insurance coverage had a 30 percent higher chance of undergoing surgery compared to those without insurance coverage. Subset analysis performed by the investigators revealed that, in patients with spinal fractures and spinal cord injuries, the difference between those who underwent surgery versus those who did not was even more pronounced for those who had insurance versus those who did not.

"In our study of over 40,000 patients from the National Trauma Data Bank, insurance coverage accounted for a 30 percent difference in the chance of getting surgery for acute spinal fractures. This discrepancy suggests that economic factors may be influencing treatment decisions," Bederman said. "Surgeons need to maintain the standard of care for all patients; however, improvements in reimbursement for the delivery of care are required."

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Andrew J. Schoenfeld, M.D., of the Northeast Ohio Medical University in Rootstown, and colleagues used the National Trauma Data Bank to assess the impact of factors such as race, ethnicity, and insurance status on spinal trauma outcomes, including mortality, complications, length of hospital stay, and length of stay in the intensive care unit.

"Our results showed that the risk of mortality was higher among African-Americans, even after adjusting for factors such as age, extent of trauma, and medical comorbidities," Schoenfeld said. "We also found that patients without health insurance had a higher risk of mortality. In addition, patients without insurance coverage had shortened hospital stays and less time in the intensive care unit. It is unclear if these patients' conditions resolved faster than others; however, that is likely not the case. It is possible that there is a health care disparity, as these patients may not be getting the same level of care as patients with insurance, but that is just a suggestive association of the study, not proven by the study."

The investigators also evaluated medical factors that could be predictive of mortality or complications and found that the presence of comorbidities influenced complications, while a patient presenting in shock influenced both the mortality and complication rate.

"Understanding these risks is important because it could enhance patient and family discussions and provide insight into realistic expectations of outcomes," Schoenfeld said.

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Michael Fehlings, M.D., Ph.D., of the University of Toronto, and colleagues evaluated whether there was a difference in outcomes among patients with cervical spondylotic myelopathy (CSM) who underwent surgery using an anterior versus posterior approach.

The investigators found that both anterior and posterior approaches were being used to treat patients with CSM. An anterior approach was more commonly used in patients with more focal pathology, who had 1 to 2 levels involved, were of a younger age, and who had less disability. A posterior approach was typically used more commonly in patients with more extensive involvement of the spine and more impairment due to the condition.

According to Fehlings, both approaches were relatively effective, with little differences in terms of outcomes and complication rates. However, patients undergoing a posterior approach had a higher wound infection rate, while patients undergoing an anterior approach had a higher rate of hoarseness of the voice and difficulty swallowing after surgery. Both approaches tended to be effective but seemed to be used in different patient populations.

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