Proceedings of the NASS 19th Annual Meeting / The Spine Journal 4 (2004) 3S–119S96S

RESULTS: After implementation of this new triage system, 3,213 (37%)patients were seen initially by a spine surgeon, of whom 1,354 (42%) requiredsurgery. Of 5,570 (63%) patients referred for treatment or nonsurgicalevaluation, 4,233 (76%) were discharged without needing a surgical con-sultation. Surgeons reviewed medical histories and images within 2 days(mean) of appointment request or receiving images. Mean wait times foran initial appointment with the neurosurgeon decreased to 20 days. Of the5,570 patients initially referred for treatment, 1337 (24%) were eventuallyreferred back to the surgeon for a surgical consult. Of those patients whosaw the surgeon after initially receiving treatment from a non-surgeon, 638(47%) received surgery. Consequently, the overall surgery rate for all newpatients seen by neurosurgeons increased from 22% to 44%.CONCLUSIONS: This new triage improved the initial management ofspine patients by facilitating effective disposition of those patients, improv-ing surgical productivity by enabling surgeons to see more patients whoneeded surgery, and qualifying most patients to begin nonsurgical treat-ment earlier.DISCLOSURES: No disclosures.CONFLICT OF INTEREST: Author (WTM) Stockholder: Member/Owner of Mayfield Clinic. Mayfield Clinic offers this triage to other neuro-surgical institutions who express interest in taking advantage of the system.

doi: 10.1016/j.spinee.2004.05.194

P18. Effects of operative positioning on sagittal alignment and slipreduction in isthmic spondylolytic patientsKingsley R. Chin, MD1, John Davis, MD2, Sanford Emery, MD3, HenryBohlman, MD4, Jung Yoo, MD5; 1University of Pennsylvania,Philadelphia, PA, USA; 2Case Western Reserve University, OH, USA;3West Virginia University, Morgantown, WV, USA; 4Spine Institute,University Hospitals of Cleveland, Cleveland, OH, USA; 5UniversityHospitals of Cleveland, Cleveland, OH, USA

BACKGROUND CONTEXT: Correct sagittal balancing of the spine isimportant for appropriate load distribution during gait. Slip reductionand prevention of flatback syndrome are desirable outcomes that can beachieved intraoperatively with surgical techniques and instrumentation.However, the operative table may affect the degree to which either canbe chieved.PURPOSE: This study determined whether the Jackson and Andrewsoperative tables affect lumbar sagittal alignment and slip reduction in isth-mic spondylolytic patients.STUDY DESIGN/SETTING: Retrospective Review of Preoperative, In-traoperative, and Postoperative Lateral Radiographs.PATIENT SAMPLE: 20 Patients.OUTCOME MEASURES: Radiographic changes in sagittal alignment.METHODS: We reviewed preoperative, intraoperative, and postoperativelateral plain radiographs of the lumbar spine in 20 patients. Radiographswere reviewed on average within 6 weeks of surgery and at a minimum6 weeks postoperatively. Intraoperative radiographs were done exposingthe spine. All patients had either grade I or II isthmic spondylolisthesisand underwent posterior decompression and posterolateral fusion with orwithout pedicle screw instrumentation. Data on nine of these patients wereanalyzed. Four patients were treated on the Andrews frame, two of whomhad instrumented fusion. Five were treated on the Jackson frame and allhad instrumented fusions.RESULTS: All patients treated on the Jackson table had improvement oftheir slip percentage, slip angle, and lumbar lordosis. In contrast, all patientson the Andrews frame had decreased lordosis and increased slip angle andpercentage. Grade II slips had more changes in slip percentage. Instrumenta-tion maintained the intraoperative positions of the lumbar spine, slip angle,and percentage slip 6 weeks after surgery. Changes in lordosis occurredprimarily between L3 and the sacrum with significantly less changes be-tween L3 and L5. Patients fused without instrumentation on the Andrewsframe settled back into their preoperative sagittal alignment.CONCLUSIONS: The Jackson table aided slip reduction in isthmic spon-dylolytic patients and should be favored over the Andrews frame when per-forming instrumented lumbar fusions in spondylolytic patients.

DISCLOSURES: No disclosures.CONFLICT OF INTEREST: No Conflicts.

doi: 10.1016/j.spinee.2004.05.195

P68. Reduced bladder and bowel control after severe spinal cordinjury even in patients able to walkWilliam Coleman, PhD1, Fred Geisler, MD, PhD2, Kim Anderson,PhD3; 1WPCMath, Buffalo, NY, USA; 2Chicago Institute ofNeurosurgery and Neuroresearch, Chicago, IL, USA; 3Reeve-IrvineResearch Center, Irvine, CA, USA

BACKGROUND CONTEXT: Although walking and unlimited mobil-ity are main goals for spinal-cord-injured (SCI) patients, more limitedaccomplishments—such as bladder and bowel control—would significantlyimprove quality of life for those lacking them. Recent conferences andpublications have cited such endpoints as under-studied.PURPOSE: To investigate the natural history of bladder and bowel controlafter severe SCI.STUDY DESIGN/SETTING: Retrospective epidemiology using the large,well-monitored database from the multi-center GM-1 trial.PATIENT SAMPLE: 760 severely injured patients at 28 centers in NorthAmerica. At weeks 4, 8, 16, 26, and 52 after injury, approximately 600 ofthese were assessed for bladder and bowel control. Injuries were rostral toT10 and left at least 1 leg with an American Spinal Injury Association(ASIA) motor score �15 of 25. Patients were assessed at baseline usingthe ASIA Impairment Scale (AIS): Grade A (n�482), Grade B (n�131),andGradesC andD(n�147), anddividedby injury level: cervical (n�579)orthoracic (n�181).OUTCOME MEASURES: Bladder control and bowel control were scoredas follows: 0=absent, 1=abnormal, 2=normal.METHODS: Fisher’s Exact Test for binary outcomes; and Chi-squared, theWilcoxon 2-Sample Test and the Median Test for nonparametric measures.Except as noted, statistical significance was set at p�.05.RESULTS: Bladder and bowel control were very strongly (p�.0001) asso-ciated with AIS severity at all time points. Proportionally more patientswith cervical injuries than with thoracic had absent bladder control atWeeks 4, 8, 16, 26, and 52; and absent bowel control at Weeks 4, 8, 16,and 52. Significantly fewer females had absent bladder or bowel control atWeeks 8 and 16. Patients with fracture dislocations had worse (p�.01)bowel and bladder control than did patients with stable injuries. Thosewith suspected central cord injuries did better (p�.0001) at all follow-ups.Patients directly admitted to tertiary care more often (p�.01) remainedwith absent bladder or bowel control, starting at Week 8. Age was not anotable factor; nor was MPSS starting before or after 3 hours; nor wasassignment to GM-1 or placebo. The association between ability to walk atWeek 26 and having bladder or bowel control at Week 8 or 26 was strong(p�.0001)—but far from perfect in one of the two directions. Of 443patients unable to walk at least 25 feet assisted, only 9 (or 7.6%) hadnormal bowel control. However, of 153 who could walk at least that well,there were 44 (or 28.8%) left with abnormal or absent bowel control. Theresults are similar for bladder control.CONCLUSIONS: Though bowel and bladder control share some similarpatterns with more commonly cited outcome measures, there are importantdifferences. At Week 26, achievement of some walking left over one quarterof the patients without normal bladder control or normal bowel control.More, 79.9% of all patients—whether walking or not—remained with lessthan normal bladder control, and 80.0% percent with less than normalbowel control. Thus these conditions, representing a serious impact onquality of life, affect a very large portion of the SCI population and representa significant separate problem needing specifically directed work.DISCLOSURES: No disclosures.CONFLICT OF INTEREST: No Conflicts.

doi: 10.1016/j.spinee.2004.05.196