CONCLUSIONS: Intravenous ketorolac appears to significantly decrease

postoperative pain and morphine requirements after primary decompres-

sive lumbar laminectomy.

FDA DEVICE/DRUG STATUS: Ketorolac: Approved for this indication.

CONFLICT OF INTEREST: No conflicts.

doi: 10.1016/j.spinee.2006.06.234

P89. Workers’ Compensation Indemnity Settlement Costs Vary

by Functional Outcome Following Sports Performance Based

Rehabilitation in Spinal Fusion Patients

Jamie Stark, PhD, CSCS, HFI1, Matthew Kruger, MS, CSCS2,

Mike Zbreski, MS3, Dylan Bates, MS4, Gregory Steil, EP5; 1ATI Physical

Therapy, Chicago, IL, USA; 2Athletic and Therapeutic Institute,

Romeoville, IL, USA; 3ATI Physical Therapy, Romeoville, IL, USA;4Athletic and Therapeutic Institute, Joliet, IL, USA; 5ATI Physical Therapy,

Willowbrook, IL, USA

BACKGROUND CONTEXT: The total case cost of spinal fusion can be

exceptionally high for worker’s compensation patients. The total case cost

is a product of the medical and nonmedical (indemnity) costs. In Illinois,

55% of the total case costs are nonmedical. In our previous studies Sports

Performance based Work Conditioning/Hardening (SPWC/H) has been

shown to be effective in increasing the functional capabilities of subjects

s/p lumbar fusion and produced return-to-work rates comparable to that

of the general population.

PURPOSE: The purpose of this study was to determine if differences in

indemnity settlement costs were related to the functional outcome follow-

ing SPWC/H for workers’ compensation spinal fusion patients in Illinois.

STUDY DESIGN/SETTING: A 4-year multi-center study utilized retro-

spective review of patient programs to assess functional capabilities of sub-

jects at SPWC/H completion. Data were collected in an outpatient

interdisciplinary rehabilitation setting.

PATIENT SAMPLE: Thirty-seven male subjects, s/p lumbar fusion, age

range 26-55. Subjects were discharged from traditional physical therapy

programs before entering the program. Subjects completed a minimum

of 4 weeks in SPWC/H, were allowed full program progression, and had

been discharged from the program for a minimum of 3 years.

OUTCOME MEASURES: Physical demand level (PDL) following

SPWC/H was determined by reviewing patient files. Return-to-work

(RTW) and settlement value were assessed by telephone interview.

METHODS: Subjects were contacted by telephone and completed a ques-

tionnaire. These results were compared with subject’s PDL following

SPWC/H. PDL was categorized according to the U.S. Dept. of Labor’s

Dictionary of Occupational Titles: MEDIUM (50 lbs), MEDIUM-HEAVY

(75 lbs), HEAVY (100 lbs), VERY-HEAVY (O100 lbs). Student t tests and

a one-way ANOVA were used to measure differences between groups.

Significance was set at p!.05. Fisher Exact test was utilized for post hoc

analysis. Data are mean 6SD.

RESULTS: Overall RTW rate following SPWC/H was 84% (31/37).

RTW rates by PDL were: MEDIUM 56% (5/9), MEDIUM-HEAVY 82%

(9/11), HEAVY 100% (6/6), VERY-HEAVY 100% (11/11). Settlement

values varied by RTW status ($393,333135,708 vs. $119,22653,786 for

RTW and NO RTW respectively; p ! .05). For patients who did RTW,

settlement values also varied by PDL (MEDIUM $205,00033,000; ME-

DIUM-HEAVY $140,00038,000; HEAVY $94,00014,000; VERY-HEAVY

$77,00024,000; p ! .05 for all groups).

CONCLUSIONS: During the settlement process for back injuries in Illi-

nois a ‘Final Disability Rating’ is ascribed to patients. These data show

that RTW status and PDL following SPWC/H affect worker’s compensa-

tion settlement values in spinal fusion patients in Illinois. These data sug-

gest that functional capabilities following SPWC/H have a direct impact on

settlement costs, thus providing an economic benefit to the workers’ com-

pensation system.

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.2006.06.235

P90. An Outcome Study of Single-level Anterior Lumbar Interbody

Fusions Utilizing rhBMP-2

Frank Bono, DO1, Douglas Geiger, MD2; 1Michigan Brain and Spine

Institute, West Bloomfield, MI, USA; 2Michigan Brain and Spine Institute,

Ypsilanti, MI, USA

BACKGROUND CONTEXT: The purpose of this study was to measure

the success rate of anterior lumbar interbody fusion using recombinant hu-

man morphogenic protein-2 for the treatment of degenerative disc disease

as compared with autogenous iliac crest bone harvest graft.

PURPOSE: The purpose of this study was to measure the success rate of

anterior lumbar interbody fusions using recombinant human morphogenic

protein-2 (rhBMP-2) for the treatment of degenerative disc disease as com-

pared with autogenous iliac crest bone harvest graft and historic controls.

Success was measured by examinging radiologic fusion rates, revision

rates, length of stay, blood loss, hip pain (vs. iliac crest bone graft),

operative time, and spinal alignment on xray.

STUDY DESIGN/SETTING: This retrospective study compared the out-

come of rhBMP-2 versus autogenous iliac crest bone graft for single-level

anterior interbody fusion using threaded cages.

PATIENT SAMPLE: A retrospective chart and radiograph review was

performed for 101 patients who underwent anterior lumbar interbody

fusion using threaded stand-alone cage. The patient population had a

minimun of 2-year follow-up.

OUTCOME MEASURES: Hospital charts, office charts, and radiographs

were used to determine success of fusion, amount of blood loss, operative

time, length of hospital stay, and number of weeks to return to work.

METHODS: Thirty-three patients who underwent anterior lumbar inter-

body fusion with stand-alone cage with recombinant bone norphogenic

protein-2 were compared with 68 patietns who underwent a similar proce-

dure using autogenous iliac crest graft. These patients had a minimum fol-

low-up of 2 years. The study focused on fusion rate, time to fusion, amount

of blood loss, graft subsidence, graft site pain, number of weeks to return

to work, length of hospital stay, and operative time.

RESULTS: The fusion rate for the BMP group was 100%. The autogenous

group had a statistically (p!.005) lower rate of fusion at 94%. Fusion rate,

amount of blood loss, operative time, length of hospital stay, and number

of weeks to return to work proved to be statistically significant in graft sub-

sidence between the two groups.

CONCLUSIONS: The results of this retrospective study confirm that

anterior lumbar interbody fusion using rhBMP-2 significantly decreased

operative blood loss, operative time, and length of hospital stay while

achieving higher fusion rates over autogenous iliac crest bone graft. These

factors may help to offset the greater cost of BMP.

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.2006.06.236

P91. Freeze-Dried versus Fresh-Frozen Allograft for Anterior

Lumbar Interbody Fusion as Part of a Circumferential Fusion

John Thalgott, MD1, James Giuffre2, Madilyne Fogarty, BS3,

Stephani Christenson, BS3, Alex Epstein4, Chunhong Ni5, Charles Aprill,

MD6; 1International Spinal Development & Research Foundation, Las

Vegas, NV, USA; 2International Spinal Development and Research

Foundation, Bridgewater, MA, USA; 3International Spinal Development

and Research Foundation, NV, USA; 4NV, USA; 5Louisiana State

University, China; 6Louisiana State University, New Orleans, LA, USA

BACKGROUND CONTEXT: One of the most widely used ALIF compo-

nents is femoral ring allograft. The femoral ring is allograph cut in the

shape of a hollow cylinder to provide strength and load-bearing stability

126S Proceedings of the NASS 21st Annual Meetings / The Spine Journal 6 (2006) 1S–161S