39SProceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S

PURPOSE: The purpose of this study is to evaluate the relationship of the

TLICS system and injury severity score with the clinical and radiographic

data as well as with treatment chosen in the setting of thoracic and lumbar

spinal trauma according to the period of time before (2000–6) and after

(2007–10) utilization of the TLICS at our institution.

STUDY DESIGN/SETTING: Retrospective study.

PATIENT SAMPLE: Analysis of 458 patients consecutively treated con-

servative and surgically for thoracic and lumbar spine trauma from 2000 to

2010 in the University of Utah School of Medicine, Salt Lake City, Utah.

OUTCOME MEASURES: The TLICS treatment recommendations were

compared with the TLICS score of the thoracolumbar spinal trauma pa-

tients treated before and after the utilization of the TLICS system in our

institution.

METHODS: Clinical and radiological data were evaluated and patients

were grouped according to the period of time before (2000–6) or after uti-

lization of the TLICS at our institution (2007-10). Injuries were described

as thoracic (T1-10), thoraco-lumbar (T11-L2) or lumbar spinal trauma

(L3-5). Demographic data including age and gender were recorded. Injury

and treatment details were also recorded, including trauma etiology, frac-

ture level, neurological status (pre and post-operative American Spinal In-

jury Association ‘‘ASIA’’ classification), surgical approach, number of

arthrodesis levels, and complications. The injuries were classified accord-

ing to the Magerl/AO Spine Classification and the TLICS score system at

the most damaged operative level. Causes of failure in the conservative

treatment were also recorded.

RESULTS: Between 2000–6, 148 patients were treated conservatively and

66 were surgically treated. In the conservative group, 147 patients were

ASIA E (99.3%) and almost all had AO type A fractures (144/147). The

TLICS score ranged from 1 to 7 (median 1; mean 1.57). In the surgical

group, 44 patients were ASIA E (66.6%) and 22 were ASIA A-D

(33.3%). 48 patients (72.7%) had AO type A fractures, 15 (31.2%) had

type B and 3 (6%) type C fractures; the TLICS score ranged from 2-10

(median 2; mean 4.14). There were 40 burst fractures without neurological

deficit (TLICS 2) surgically treated (60.6%). Between 2007–10, 162 pa-

tients were treated conservatively and 82 were surgically treated. In the

conservative group, all patients were ASIA E and 160 (98.7%) had an

AO type A. TLICS score ranged from 1 to 4 (median 1; mean 1.48). In

the surgical group, 61 (74.3%) patients were ASIA E and 21 (25.6%) ASIA

A-D. The AO distribution included 55 (67%) type A fractures, 21 type B

(25.6%) fractures, and 6 (7.3%) type C fractures. The TLICS score ranged

from 2-10 (median 4; mean 4.4), with 39 patients (47.5%) having burst

fractures without neurological deficit (TLICS 2). Failure of conservative

treatment occurred in nine patients: 3 had distractive injuries initially mis-

diagnosed (TLICS 7), one patient had a burst fracture with refractory rad-

iculopathy (TLICS 4), and 5 had burst fractures (TLICS 2) with pain or

progressive kyphosis. Most failures (7/9) and all missed distractive injuries

occurred prior to 2007.

CONCLUSIONS: The TLICS tends to treat stable injuries more conser-

vatively, with a positive impact on guiding non-surgical care. After the

TLICS, failure of non-operative treatment tends to decrease.

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

any applicable devices or drugs.

doi: 10.1016/j.spinee.2011.08.103

73. Reduced Surgical Site Infections in Patients Undergoing

Posterior Spinal Stabilization of Traumatic Injuries Using

Vancomycin Powder

Kevin O’Neill, MD, Jason Smith, Amir Abtahi, MD, Kristin Archer, PhD,

DPT, Dan Spengler, MD, Matthew McGirt, MD, Clinton J. Devin, MD;

Vanderbilt University Medical Center, Nashville, TN, USA

BACKGROUND CONTEXT: Despite improvements through the use of

prophylactic systemic antibiotics, surgical site infections remain a signifi-

cant problem in the treatment of traumatic spine injuries. Infection rates as

All referenced figures and tables will be available at the Annual Mee

high as 10% have been reported in this population. The impact on patients

and cost of treating such infections is profound. Local delivery of antibi-

otics has been found to be efficacious in animal and human studies as

an adjunct to systemic antibiotics in surgical site infection prophylaxis.

PURPOSE: Evaluate the efficacy of using vancomycin powder in surgical

sites to prevent infections.

STUDY DESIGN/SETTING: Retrospective case review.

PATIENT SAMPLE: Patients who underwent posterior spine fusions for

traumatic injuries over a 2-year period at a single academic center.

OUTCOME MEASURES: Clinical outcome determined was the inci-

dence of either superficial or deep post-operative wound infections.

METHODS: A retrospective review of 117 patients with traumatic spine

injuries treated with instrumented posterior spine fusions over a 2 year pe-

riod at a single academic center was performed. One group (control group)

received standard systemic prophylaxis only, while another (treatment

group) received vancomycin powder in the surgical wound in addition to

systemic prophylaxis. Patient demographics and perioperative information

obtained included: history of previous spine surgeries, substance use, dia-

betes, body mass index, level of injury, presence of neurologic deficit, op-

erative time, and estimated blood loss. Incidence of infection was the

primary outcome evaluated.

RESULTS: The control (N557) and treatment groups (N560) were sta-

tistically similar. A statistically significant difference in infection rate

was found between the treatment group (0%) and control group (12%,

p5.02) without any adverse events. No adverse effects were noted from

use of the vancomycin powder.

CONCLUSIONS: The use of vancomycin powder in surgical wounds

may significantly reduce the incidence of infection in patients with trau-

matic spine injuries treated with instrumented posterior spine fusion. Ap-

plying vancomycin powder to surgical wounds is a promising means of

preventing costly and harmful post-operative wound infections in high risk

populations.

FDA DEVICE/DRUG STATUS: Vancomycin: Not approved for this

indication.

doi: 10.1016/j.spinee.2011.08.104

74. Does MRI Change Preoperative Planning in the Treatment of

Acute Cervical Spine Trauma?

Michael Faloon, MD1, Ki Hwang, MD2, Sima Pourtaheri3,

Kumar Sinha, MD4, Dipak Patel, MD3, Conor Dunn3, Arash Emami, MD4;1Hoboken, NJ, USA; 2University Place Spine Center, Wayne, NJ, USA;3Englewood, NJ, USA; 4University Spine Center, Wayne, NJ, USA

BACKGROUND CONTEXT: Decision making in the treatment of acute

cervical spine trauma can be difficult considering the lack of consensus for

pre-operative management protocols. The role and utility of magnetic

resonance imaging in the treatment algorithm of these injuries is yet to

be defined. This is especially true regarding patients with alteration in

sensorium.

PURPOSE: To evaluate the role of MRI in the preoperative surgical

planning of patients treated for acute cervical trauma and determine if

MRI influences management and operative treatment.

STUDY DESIGN/SETTING: Retrospective case series of 102 consecu-

tive patients treated for acute cervical trauma injuries at a single trauma

center.

PATIENT SAMPLE: Trauma patients diagnosed with fracture or liga-

mentous injury to the atlanto-axial or subaxial spine and complete clinical

and radiographic records were included in the data analysis.

OUTCOME MEASURES: Patients whose treatment plan was altered

secondary to information provided by magnetic resonance imaging as

compared to screening computed tomography modalities was determined

by two fellowship trained spine surgeons.

METHODS: Clinical and radiographic data of patients with acute cervical

trauma over a five year period was reviewed. Patients were divided into

ting and will be included with the post-meeting online content.