103SProceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S

outcome scores at one year are only fair predictors of outcome scores at

two years.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi:10.1016/j.spinee.2008.06.244

P3. RT-PCR and Microarray Experimental Xtudy for the Impact of

Methylprednisolone and Sodium Channel Blocker on Axonal

Growth after Acute Spinal Cord Injury in Rats

Jun-Young Yang, MD, June-Kyu Lee, MD, PhD, Ho Sup Song, Eui

Pyo Hong; Daejeon, Daejeon, South Korea

BACKGROUND CONTEXT: Pharmacological interventions for acute

spinal cord injury advocate the use of neuroprotective drugs in the early

management in order to reduce the extent of neurological disability. There

are no data about what impact of administration of MP and riluzole simul-

taneously on axonal growth.

PURPOSE: To determine the the impact of methylprednisolone(MP) and

sodium channel blocker(Riluzole) on axonal growth after acute spinal cord

injury(SCI) in rats.

STUDY DESIGN/ SETTING: Animal study.

PATIENT SAMPLE: 48 spinal cord injured SD rats.

OUTCOME MEASURES: Behaviorial test, RT-PCR and in situ hybrid-

yzation for chondroitin sulfate proteoglycans and the change of transcrip-

tion factor including c-JUN, ATF-2, p53 and ElK-1 using microarray.

Student Test was performed (P!0.05).

METHODS: The SCI models of SD rat were divided into 2 groups. Group

I was injected with saline(1ml/kg) and group II was injected MP(300mg/

kg) with riluzole(5mg/kg) simultaneously. We evlauated behaviorial test,

RT-PCR and in situ hybridyzation for chondroitin sulfate proteogly-

cans(CSPG) and the change of transcription factor including c-JUN,

ATF-2, p53 and ElK-1 which related with MAPK pathway using microar-

ray method in each group.

RESULTS: On behaviorial test used BBB scoring system, the differences

between I and II had a statistical significance at 4th and 7th day (P!0.05),

while two groups did not have difference statistically at 1st day after SCI.

In RT-PCR and in-situ hybridyzation for CSPG, we found significance

differences between groups at 4th and 7th day after SCI and also noted large

cavity and more expression of CSPG in group I. The change of c-JUN was on

the increase immediately and then drop and increment in group I, but in-

creased with the lapse of time in group II. The degree of c-JUN in group II

at 7th day was less than in group I at 1st day. The expression of ATF-2 was

increased with the lapse of time but group II was less expressed than group

I with statistical differences. The pattern of p53 expression in group I was

down-regulation with the lapse of time. In group II, down-regulation was

noted at 4th day and then the increment was noted at 7th day. we found sig-

nificance differences at 7th day only. The change of Elk-1 was more compli-

cated; up-regualtion in group I and II at 4th day, and then plateau in group I,

but down-regulation in group II.

CONCLUSIONS: Taken together theses results, MP and riluzole were

confirmed to have a neuroprotective effect in view of various transcription

factors which related with MAPK pathway and CSPG production which

from glial scar. So, this study afford the basic data to future studies about

the clinical relevances and effectiveness of methylprednisolone with rilu-

zole for acute spinal cord injured patients

FDA DEVICE/DRUG STATUS: Methylprednisolone: Approved for this

indication; Riluzole: Investigational/Not approved.

doi:10.1016/j.spinee.2008.06.245

P4. Effects on Spinal Cord Blood Flow and Neurologic Function

Secondary to Interruption of Bilateral Segmental Arteries which

Supply the Artery of Adamkiewicz: An Experimental Study using

a Dog Model

Satoshi Kato, MD, Norio Kawahara, MD, Hideki Murakami, MD,

Satoru Demura, MD, Yoshiyasu Fujimaki, RN, Katsuro Tomita, MD;

Department of Orthopaedic Surgery, Kanazawa University, Kanazawa,

Japan

BACKGROUND CONTEXT: Interruption of bilateral segmental arteries

at 5 or more consecutive levels without the level of Adamkiewicz artery

has been reported to risk producing ischemic spinal cord dysfunction in

a canine model. However, the effects of ligating including the level of

Adamkiewicz artery have not been elucidated.

PURPOSE: To examine how many ligations of bilateral segmental arteries

including the level of Adamkiewicz artery cause ischemic spinal cord

dysfunction.

STUDY DESIGN/ SETTING: Segmental arteries including the level of

Adamkiewicz artery were interrupted bilaterally for up to 4 levels to study

the effects on spinal cord blood flow and neurologic function in dogs.

PATIENT SAMPLE: The 25 female dogs in which Adamkiewicz artery

originated from L5 level were taken in this study. 15 dogs were used

to perform physiological measurements (Experiment 1), and the other 10

dogs were used to observe postoperative neurologic function (Experiment 2).

OUTCOME MEASURES: Spinal cord blood flow (SCBF), spinal cord

evoled potentials (SCEPs), and compound muscle action potentials (CMAPs)

were measured and postoperative neurologic function was assessed.

METHODS: (Experiment 1) 15 dogs were divided into 5 groups: sham

group, no ligation; group 1, ligation of bilateral segmental arteries at 1

level (L5); group 2, at 2 levels (L4-5); group 3, at 3 levels (L4-6); group

4, at 4 levels (L3-6). SCBF at the L5 spinal cord segment by laser-Doppler

flowmetry, SCEPs and CMAPs were measured simultaneously until 10

hours after ligation. For SCEPs, the amplitude from baseline to the first

negative peak was measured. For CMAPs, it was measured between the

maximal negative and positive peaks. Decreases more than 50% of the

control SCEPs and CMAPs were considered to be abnormal. (Experiment

2) Neurologic function was assessed using a modified Tarlov grading sys-

tem 1 week after operation in 10 other dogs divided into 2 groups: 3 pairs

group, ligation at 3 levels (L4-6); 4 pairs group, at 4 levels (L3-6).

RESULTS: In sham group, SCBF was 98.262.1% 10 hours after ligation.

The amplitudes of SCEPs remained higher than 90% and the amplitudes

of CMAPs remained higher than 80% of the control values during the 10

104S Proceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S

hours. In group 1, SCBF was 76.166.2% 10 hours after ligation. The ampli-

tudes of SCEPs remained higher than 70% and the amplitudes of CMAPs re-

mained higher than 80% of the control values during the 10 hours. In group 2,

SCBF was 66.666.6% 10 hours after ligation. The amplitudes of SCEPs and

CMAPs remained higher than 60% of the control values during the 10 hours.

In group 3, SCBF was 61.462.1% 10 hours after ligation. The amplitudes of

SCEPs remained higher than 60% and the amplitude of CMAPs remained

higher than 50% of the control values during the 10 hours. In group 4, SCBF

was 53.565.5% 10 hours after ligation. Abnormal SCEPs and CMAPs were

observed in 1 out of 3 dogs. Postoperative neurologic evaluation identified all

5 dogs in 3 pairs group and 4 in 4 pairs group as having grade 5. There was 1

dog in 4 pairs group that had grade 4. (grade 4, animal can walk: grade 5, an-

imal can climb a 20� inclined plane).

CONCLUSIONS: Interruption of bilateral segmental arteries at 4 or more

consecutive levels including the level of Adamkiewicz artery risks produc-

ing ischemic spinal cord dysfunction.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi:10.1016/j.spinee.2008.06.246

P5. Fullendoscopic Dorsal Foraminotomy vs. Ventral Decompression

and Fusion in Cervical Lateral Disc Herniations: A Prospective

Randomized Controlled Study

Sebastian Ruetten, MD, PhD1, Martin Komp, MD, PhD1, Harry Merk2,

Georgios Godolias1; 1Herne, Germany; 2Greifswald, Germany

BACKGROUND CONTEXT: There are various techniques for the oper-

ation of cervical disc herniations. The most common today appears to be

ventral decompression and fusion. It brings good results, but requires more

major surgery with loss of segment mobility. Dorsal "keyhole foraminoto-

my" is also been used without fusion. This operation is now possible in

a full-endoscopic technique.

PURPOSE: The objective of the prospective randomized study was to

compare ventral decompression and fusion (Group 1) to full-endoscopic

dorsal decompression (Group 2) in lateral, soft disc herniations.

STUDY DESIGN/ SETTING: Prospectice, randomized, controlled study.

PATIENT SAMPLE: 35 patients each underwent conventional microsur-

gical ACDF, or decompression via full-endoscopic posterior cervical fora-

minotomy (FPCF). Randomization was open, since the patients may

identify the operation procedure.

OUTCOME MEASURES: In addition to general parameters, other infor-

mation was obtained using the following instruments: a VAS for neck and

arm pain, the German version of the North American Spine Society Instru-

ment (NASS), Hilibrand criteria based on Smith and Robinson.

METHODS: Inclusion criteria were: monosegmental mediolateral and

lateral soft disc herniation, radicular pain. In Group 1, the operation was

performed in known technique using a PEEK cage without plating. In

Group 2, the operation was performed using 5.9-mm endoscopes with

a 3.1-mm intraendoscopic working canal under continuous lavage. The

follow-up lasted 24 months. 62 patients (88%) were followed.

RESULTS: The mean operation time in Group 1 was 75 minutes., in

Group 2 35 minutes There were no measurable blood loss and serious com-

plications in either group. In Group 1, 2 patients had transient difficulty

swallowing. In Group 2, transient numbness occurred twice. There was

no operation-related neck pain in Group 2 after wound healing. One patient

in Group 2 suffered recurrence. CT-examinations showed resection of less

than 1/4 of the facettes in Group 2. There was no increasing instability or

kyphosing in Group 2, in Group 1 no adjacent instability. 57 patients sub-

jectively attained a satisfactory result. This corresponded to the signifi-

cantly constant improvement recorded by the validated measuring

instruments. There were no significant differences between the groups.

CONCLUSIONS: Full-endoscopic dorsal foraminotomy is technically

feasible and a potential alternative to ventral decompression and fusion.

It enables a selective procedure with direct visualization, decompression

is rapid, sufficient and the complication rate is low. Traumatization of the ac-

cess pathway and the structures of the spinal canal is reduced due to the

minimally-invasive technique. Strict attention must be paid to the indica-

tion for lateral and soft disc herniation. Recurrences cannot be ruled out.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi:10.1016/j.spinee.2008.06.247

P6. Are Preoperative HRQOL Scores Predictive of Clinical

Outcomes after Lumbar Fusion?

Leah Carreon, MD, MSc1, Steven Glassman, MD2, Mladen Djurasovic,

MD1, John Dimar, II, MD1, John Johnson, MD2, Rolando Puno, MD2,

Mitchell Campbell, MD2; 1Louisville, KY, USA; 2Leatherman Spine Center,

Louisville, KY, USA

BACKGROUND CONTEXT: Specific and generic measures of Health-

related quality of life (HRQOL) such as the SF-36 and Oswestry Disability

Index (ODI) are increasingly being used to evaluate effectiveness of treat-

ments such as lumbar fusion for degenerative disorders of the lumbar

spine. However, their use as a diagnostic tool to determine which patients

will improve has been limited.

PURPOSE: The purpose of this study is to determine the effect of pre-op

MCS, pre-op PCS, pre-op ODI, predominance of back pain, BMI, age,

smoking status, procedure performed, number of levels fused and worker’s

compensation on HRQOL after lumbar fusion. These factors were selected

as they may influence a surgeon’s decision-making process.

STUDY DESIGN/ SETTING: Cross-sectional cohort.

PATIENT SAMPLE: 489 patients who underwent lumbar fusion for de-

generative spine disorders.

OUTCOME MEASURES: SF-36, ODI, and numeric rating scales for

back (BPNRS) and leg pain (LPNRS).

METHODS: SF-36, ODI, BPNRS and LPNRS were collected prospec-

tively, pre-operatively and two years, post-operatively in patients undergo-

ing lumbar fusion for degenerative disorders. Linear regression modeling

was used to determine the effect of pre-op MCS, pre-op PCS, pre-op

ODI, predominance of back pain, BMI, age, smoking status, procedure

performed, number of levels fused and worker’s compensation on the

change in ODI and change in SF-36 PCS two years after lumbar fusion.

Procedures performed included PSF, TLIF, AIF and circumferential fusion.

RESULTS: Patients with better pre-op MCS (p50.008) and worse pre-op

ODI scores (p!0.0001) achieved greater improvements in ODI. Worker’s

compensation patients did significantly worse (p50.03). Patients with bet-

ter pre-op MCS (p50.0004), better pre-op PCS (p50.0155) and worse pre-

op ODI scores (p50.0210) achieved greater improvements in PCS. Those

on worker’s compensation experienced lower changes in PCS, an effect

that was nearly significant (p50.0644). There were no significant correla-

tions between improvement in PCS and ODI and predominance of back

pain, BMI, age, smoking status, procedure performed, and number of

levels fused. Attempts at determining threshold values for MCS, PCS

and ODI that are predictive of a patient achieving minimum clinically im-

portant difference for PCS and ODI using receiver-operating characteristic

curves, pair-wise comparisons and recursive partitioning algorithms were

unsuccessful.

CONCLUSIONS: Patients with good pre-op MCS and poor pre-op ODI

scores who are not on worker’s compensation are more likely improve af-

ter lumbar fusion. Non-modifiable pre-operative factors, operative and

post-operative events may also affect clinical outcomes after lumbar fu-

sion. Threshold values for MCS, PCS and ODI that are predictive of a pa-

tient achieving minimum clinically important difference for PCS and ODI

could not be determined.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi:10.1016/j.spinee.2008.06.248