Proceedings of the NASS 20th Annual Meeting / The Spine Journal 5 (2005) 1S–189S36S

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

doi: 10.1016/j.spinee.2005.05.069

operated interspace rather than though an open laminectomy defect therebygiving the same control of catheter insertion as percutaneously placedcatheters. Furthermore leakage of the infusion solution into the wound viathe laminectomy defect is minimized and analgesic efficacy is maximized.PURPOSE: Is this new technique for immediate postoperative pain man-agement safe? Is it practical and effective in achieving postoperative paincontrol?STUDY DESIGN/SETTING: See “Methods” below.PATIENT SAMPLE: 151 consecutive patients who underwent posteriorlumbar spinal fusion with instrumentation by one of three surgeons.OUTCOME MEASURES: Conditions that prevented catheter placementand complications associated with epidural catheter placement and periop-erative analgesic infusion were logged. Immediate postoperative patientfunction was evaluated and supplemental parenteral analgesic requirementswas assessed.METHODS: All 151 patients were consented for postoperative epiduralanalgesia. Oneof two anesthesiologistsprovidedperioperativeanestheticandpain management care for each patient. Technique: Prior to fascial closurean intact epidural interspace one or two levels cephalad to the most cephalad-instrumented segment is exposed. Using a paramedian approach, an 18gauge Crawford needle is advanced into the epidural space under loss ofresistance to preservative free normal saline. A 20 gauge epidural catheteris then introduced and advanced 2 cm. A 15 cm Touhy-Schiff needleis introduced through the skin approximately 12 cm cephalad to the uppermargin of the incision and advanced until the of the needle appears adjacentto the catheter, deep to the fascia. The catheter is then passed retrogradethrough the Crawford needle. The catheter thus exits the skin site wellabove the most cephalad aspect of the wound. A test dose is administered andthe infusion (usually a dilute mixture of preservative-free hydromorphoneand preservative-free clonidine) is begun in the post anesthesia care unit,once the patient is awake. The patient is converted to oral analgesic therapyand the epidural catheter is removed prior to discharge between postopera-tive days 2 and 5.RESULTS: Two of the 151 patients did not have catheter placement dueto coagulopathy. None of the 149 catheterized patients developed anycomplication directly or indirectly related to catheter insertion techniqueor its presence. Patients began in-hospital rehabilitation with their cathetersin place with mobilization being as or more rapid than similar patients usingother forms of pain management. The catheterized patients used less break-through narcotic as well. The vast majorityof these patients were converted tooral analgesics with only a few requiring conversion to intravenous narcoticanalgesia, and had a shorter length of stay than those treated with otherforms of pain management.CONCLUSIONS: This newly described technique of postoperative painmanagement appears safe, practical and effective. It minimizes impairmentof patient sensorium compared with parenteral analgesic techniques therebyexpediting impatient rehabilitation and discharge.DISCLOSURES: No disclosures.CONFLICT OF INTEREST: No conflicts.

doi: 10.1016/j.spinee.2005.05.071

5:4368. MRI indicators of SPECT positive facet diseaseAnthony Kim, MD, Michael Wang, MD; University of SouthernCalifornia, Los Angeles, CA, USA

BACKGROUND CONTEXT: Many reports have indicated that the facetjoints are a common cause of axial low back pain. However, a majorproblem with diagnosing facet disease has been the poor correlation betweenradiographic signs of joint degeneration and pain symptoms. SPECT radio-nuclide scanning has proven to be one of the more reliable and objectivetechniques to demonstrate the facet syndrome. However, MRI is a muchmore commonly employed test in patients with low back pain. Correlationsbetween SPECT and MRI could prove useful for diagnosing patients withfacet disease.PURPOSE: The purpose of this study was to determine if specific character-istics of the facet joints on MRI could predict a positive SPECT scan.STUDY DESIGN/SETTING: This study was a retrospective blinded anal-ysis of the imaging findings on MRI and SPECT scanning. Facet jointswere graded for SPECT radionuclide uptake on a four-point scale.PATIENT SAMPLE: Eighteen patients with severe axial back pain whohad undergone both SPECT and MRI scanning of the lumbar spine and hadincreased radionuclide uptake in at least one facet joint. These patientswere selected out of a total of 252 patients seen over a 2-year period, theremainder of whom had negative SPECT scans. 129 facet joints from L2/3to L5/S1 were investigated; levels that had been treated surgically werenot considered.OUTCOME MEASURES: Quantitative and morphometric measurementswere obtained from the axial MRI images. Imaging characteristics andquantification for the two modalities were obtained by different observersurgeons blinded to the results of the other test.METHODS: Staistical analysis of the imaging results were obtained usingpositive and negative predictive values.RESULTS: Abnormal SPECT activity was identified in 37 joints, andstructural findings on T2 MRI images correlated with SPECT activity.Facet cartilage discontinuity was identified in 78 joints. Discontinuity hada sensitivity of 0.79 and specificity of 0.45. Lateral breaches in the synovialjoint identified by a “hook-like” appearance in the joint were identified in23 joints. This finding had a sensitivity of 0.49 and specificity of 0.95.CONCLUSIONS: MRI evidence of discontinuity in the articular cartilageof the lumbar facet joints was a sensitive indicator of a “hot” facet joint,while breaches in the synovial capsule were highly specific for a positiveSPECT test. These findings may aid physicians in the identification ofsymptomatic facet disease.DISCLOSURES: No disclosures.CONFLICT OF INTEREST: No conflicts.

doi: 10.1016/j.spinee.2005.05.070

5:4969. Transincisionally placed epidural catheters for postoperativeanalgesia in instrumented lumbar spinal fusion surgeryJeffrey Coe, MD, Jeffrey Kanel, MD, Christopher Viale, MD,Randall Seago, MD, Iqbal Mirza, MD; Center for Spinal Deformity andInjury, Los Gatos, CA, USA

BACKGROUND CONTEXT: The use of epidural catheters for postopera-tive analgesia in spine surgery has been previously reported. The techniquedescribed herein varies from previously described intraoperative epiduralcatheterization techniques with epidural catheter placement through a non-

Wednesday, September 28, 20055:31–6:31 PM

SIPP 7: Lumbar Fusion Outcomes

5:3170. SF36 outcomes after lumbar spine fusion: amulticenter experienceSteven Glassman, MD1, Matthew F. Gornet, MD2, Charles Branch,MD3, David Polly, Jr., MD4, John Peloza, MD5, James D. Schwender,MD4, Leah Carreon, MD1; 1Leatherman Spine Center, Louisville, KY,USA; 2Missouri Bone and Joint Center, St. Louis, MO, USA; 3Wake