significant difference in the recovery rate of JOA score between Group-O

(74.4%) and Group-NO (72.7%).

CONCLUSIONS: Correction loss of the radiographic parameters except

%PDH was significantly greater in the patients with osteoporosis than

those without. However, no significant correlation between radiographical

and clinical results was indicated. It was clearly demonstrated that osteo-

porosis significantly contributed to postoperative correction loss of the re-

constructed spine by TLIF using Brantigan I/F cages in postmenopausal

women. To deeply understand the clinical significance of postoperative

correction loss, further study with longer follow-up is necessary.

FDA DEVICE/DRUG STATUS: Brantigan I/F cage: Approved for this

indication.

CONFLICT OF INTEREST: No conflicts.

doi: 10.1016/j.spinee.2006.06.325

P117. Management of Multilevel Cervical Spondylotic Myelopathy

(CSM) by Posterior Decompression and Instrumented Fusion:

Indications, Results, and Outcomes in a Series of 93 Cases

Arvind Kulkarni, MS (Orth) D’Orth FCPS1, Eric Massicotte, MD, MSc,

FRCSC2, Julio Furlan, MD, MBA, PhD2, Michael Fehlings, MD, PhD,

FRCS (C)2; 1Gokak, Karnataka, India; 2Toronto Western Hospital,

Ontario, Canada

BACKGROUND CONTEXT: While cervical laminectomy and instru-

mented fusion is an increasingly used treatment option for CSM, surpris-

ingly few outcomes data are available regarding this approach.

PURPOSE: Analysis of a consecutive series of 103 cases that underwent

cervical laminectomy and instrumented fusion for CSM.

STUDY DESIGN/SETTING: Retrospective cohort analysis of a consecu-

tive series of 103 cases that underwent cervical laminectomy and instru-

mented fusion for CSM. Sex, age, diabetes mellitus (DM), hypertension,

postoperative complications, and smoking were considered potential

co-variates.

PATIENT SAMPLE: Ten patients were excluded from the analysis due to

lack of follow-up data, the co-existence of cervical dystonia, or combined

anterior/posterior surgery. There were two perioperative deaths (2%).

Ninety-one patients had complete Nurick data (59 M, 32 F; ages: 33 to

88 years).

OUTCOME MEASURES: Nurick scale.

METHODS: The Nurick scale was the principal outcome measure used to

assess neurological improvement. The Charlson Index was used to

quantify comorbidities. Data were analyzed using Fisher Exact test,

Mantel-Haenszel chi-square test, paired t test, Mann-Whitney U test, and

multivariate analysis.

RESULTS: At final follow-up (mean 17 months), 50, 34, and 5 patients

had a better, unchanged, or worsened Nurick score respectively. The post-

operative Nurick scores (2.460.2) significantly improved over the preop-

erative Nurick scores (3.260.2, p!.0001). Postoperative complications

occurred in 22.8% of the patients. Diabetics had worse baseline and fol-

low-up Nurick scores than nondiabetic patients (p5.022). Using multivari-

able analysis (R250.763, F513.78, p!.0001), the postoperative Nurick

score adjusted for baseline (p!.0001) was not significantly affected by

sex (p50.079), age (p50.229), diabetes (p50.107), hypertension

(p50.33), smoking (p50.849), duration of preoperative symptoms

(p50.65), or postoperative complications (p50.834). The mean Charlson

Index was not significantly associated with worse outcomes based on

Nurick scores.

CONCLUSIONS: Despite significant co-morbidities in these patients,

multilevel laminectomy and instrumented fusion improves or stabilizes

the disability caused by CSM in 95% of patients.

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

any applicable devices or drugs.

CONFLICT OF INTEREST: No conflicts.

doi: 10.1016/j.spinee.2006.06.326

140S Proceedings of the NASS 21st Annual Meeting / The Spine Journal 6 (2006) 1S–161S

P118. Results From Grade II, III, and IV Spondylolisthesis With

Open Reduction and Posterior Lumbar Interbody Fusion

Michael Ramsey, MD, FAAOS; West Texas Spine, P.A., Odessa, TX, USA

BACKGROUND CONTEXT: Surgical treatment for Grade II, III, and IV

spondylolisthesis varies from fusion in situ, fusion with pedicle screws, fu-

sion with pedicle screw and decompression, to fusion with instrumentation

and reduction. However, high complication rates and high rates of neuro-

logic injury have been reported for patients undergoing open reduction and

fusion with fixation. Unfortunately, few studies have looked at this patient

group.

PURPOSE: The purpose of this study is to evaluate the efficacy of PLIF

with open reduction method, fusion rates, clinical outcome, and complica-

tions (including neurologic injury) on Grade II through IV

spondylolisthesis.

STUDY DESIGN/SETTING: The study was designed to look at Grade II,

III, and IV spondylolisthesis that had open reduction with instrumentation

and posterior lumbar interbody fusion (PLIF).

PATIENT SAMPLE: 20 patients.

OUTCOME MEASURES: Independent radiologists using radiographs,

CT scans, and MRI were used to determine slip angle, percent of slip,

and fusion rates. Clinical outcome was evaluated by pre- and postoperative

Prolo scores.

METHODS: A prospective review of 20 patients with Grade II, III, and

IV spondylolisthesis who underwent open reduction and PLIF by one

surgeon using the Alphatec Zodiac reduction pedicle screw and interbody

cages. All patients had greater than 1 year follow-up. The patients’ clinical

outcome was evaluated by Prolo score and pain level score pre- and post-

operatively. All patients had full neurologic evaluation pre- and postoper-

atively. Fusion was evaluated by independent radiologists using AP and

lateral radiographs. If the X-rays were inconclusive, a CT was used to

evaluate the fusion. Pre- and postoperative radiographs were reviewed to

evaluate slip angle and Meyerding classification (percent slip). A chart

review was performed looking at factors affecting outcome. All operative,

perioperative, and postoperative complications were recorded.

RESULTS: All 20 patients appeared to be fused at 1 year follow-ups. Ex-

cellent results were obtained in 15 patients. Good results were obtained in

four patients. Fair result was obtained in one patient. No new neurologic

injury was noted postoperatively.

CONCLUSIONS: Open reduction and PLIF for Grade II, III, and IV

spondylolisthesis is a technically demanding procedure with many known

complications. However, open reduction and PLIF for Grade II-IV spondy-

lolisthesis appears to be a safe, reasonable procedure for this group of pa-

tients, and apppears to have high fusion rates with good clinical outcome.

FDA DEVICE/DRUG STATUS: Alphatec Zodiac poly-axial pedicle

screw: Approved for this indication.

CONFLICT OF INTEREST: Author (MR) Royalties: Alphatec

doi: 10.1016/j.spinee.2006.06.327

P119. Sacral Insufficiency Fractures Caudal to Instrumented

Posterior Lumbosacral Arthrodesis

Eric Klineberg1, Timothy McHenry2, Carlo Bellabarba, MD1,

Theodore Wagner, MD1, Jens Chapman, MD1; 1University of Washington,

Seattle, WA, USA; 2United States Army, Ft. Sam, Houston, TX, USA

BACKGROUND CONTEXT: Sacral insufficiency fracture is a rare and

poorly understood complication of lumbosacral arthrodesis. Without a high

index of suspicion, this entity can be easily overlooked, causing a delay in

diagnosis. Several case reports have described the successful management

of these sacral fractures with bracing and medical treatment of osteoporo-

sis. However, sacral insufficiency fractures with significant displacement,

sagittal imbalance, neurologic symptoms, or painful nonunion may neces-

sitate surgical stabilization. At our institution, these fractures are preferen-

tially treated by nonoperative means. If these methods fail, stabilization is

performed using lumbopelvic fixation.