CONCLUSIONS: In order to achieve grafted bone union, rigid immobi-

lization of the grafts is required. At the same time, adequate stress must be

transmitted to the graft bone during the reparative period to stimulate the

repair as well. The balance between these two factors is most important.

We have made it clear that spinal reconstruction of posterior multilevel

pedicle screw fixation with the anterior titanium mesh cage reconstruction

method might allow adequate stress for remodeling of the bone graft inside

the titanium mesh cage using a finite element method. Our overall results

show this spinal reconstruction method is reliable for achieving bilological

fusion in the patients who underwent TES operation and in whom a rela-

tively long survival is expected. However, further development should be

required for TES in the lower lumbar level.

FDA DEVICE/DRUG STATUS: Titanium Mesh Cage: Approved for this

indication.

CONFLICT OF INTEREST: No conflicts.

doi: 10.1016/j.spinee.2006.06.082

Thursday, September 28, 200610:02–10:45 AM

General Session: Outcomes in the Aging Spine

10:02

61. Minimum Acceptable Outcomes and Expectations After Fusion

for Degenerative Disc Disease

Eugene Carragee, MD1, Ivan Cheng, MD2, Brian J.C. Freeman, MD,

FRCS3, Mark J. Wang, MD1, Todd F. Alamin, MD4, Erica Van Den Haak,

BS1; 1Stanford University, Stanford, CA, USA; 2Stanford School of

Medicine, Stanford, CA, USA; 3Queen’s Medical Centre Nottingham,

Nottingham, CA, USA; 4Stanford University School of Medicine, Stanford,

CA, USA

BACKGROUND CONTEXT: While many studies have attempted to

quantify objective observations and subjective patient reports, it remains

problematic to define success after spinal surgery. In previous reports we

have determined the minimal acceptable and expected outcomes of spinal

fusion for different diagnoses. In this paper we report on the achievement

of minimal acceptable outcome after spinal surgery for degenerative disc

disease at two major centers.

PURPOSE: To determine the rate of achievement of ‘‘expected’’ and

‘‘minimally acceptable’’ outcomes in patients having spinal surgery for

DDD.

STUDY DESIGN/SETTING: Clinical descriptive study of outcomes af-

ter spinal fusions for DDD compared with expectations and minimal ac-

ceptable outcomes determined prospectively in patients having spinal

fusion.

PATIENT SAMPLE: 94 consecutive patients awaiting surgery for DDD

were evaluated to determine baseline expectations and minimum accept-

able outcomes. 111 patients having anterior-posterior fusion for DDD at

two large academic centers were followed for 2 years to determine the

rates of achievement of expected and minimum acceptable outcomes.

OUTCOME MEASURES: Outcomes were assessed using the visual an-

alog scale (VAS) for the severity of back and leg pain, the Oswestry Dis-

ability Index (ODI), pain medication usage, and work loss by standard

questionnaire.

METHODS: Minimum acceptable outcome and expectations were deter-

mined prospectively in 94 consecutive degenerative disc patients (38 male,

56 female). Baseline preoperative values were assessed using the visual an-

alog scale (VAS) for the severity of back and leg pain, the Oswestry Dis-

ability Index (ODI), and a standard questionnaire which recorded a history

of pain medication usage, preoperative symptom duration, work status, and

amount of preoperative work loss. These subjects were then given two

standardized forms to complete, indicating both minimum-acceptable

and expected outcomes, and signifying lowest level of outcome for which

they would undergo surgery and the outcome they expect to have postop-

eratively, respectively. Subjects from two large academic centers were fol-

lowed for 2 years and their outcomes were compared with the expected and

minimally acceptable outcomes previously determined.

RESULTS: Subjects about to undergo fusion for degenerative disc disease

group indicated the average minimally acceptable improvement to be ODI-

min529.2, VASmin54.02/10, and an expected improvement to be ODI-

exp537.5 (p ! .001) and VASexp55.32/10 (p ! .001). 90% of subjects

expected to go off all narcotics and be working in some capacity. Approx-

imately 50% of subjects at each center met minimally acceptable outcomes

for pain and ODI, but few met minimal acceptable medication and work

levels. Less than 30% of patients met the ‘‘expected’’ outcomes for pain,

ODI, medications, or work status.

CONCLUSIONS: Patients with degenerative disc disease have relatively

high minimal and expected outcomes for spinal fusion when agreeing to

surgery. These outcome expectations exceed the minimally clinically

important difference referenced in previous studies and are not met in a

majority of subjects.

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.2006.06.394

10:08

62. Hip-Spine Syndrome: The Effect of Total Hip Replacement

Surgery Upon Low Back Pain in Patients With Severe Osteoarthritis

of the Hip

Peleg Ben-Galim, MD1, Tal Ben-Galim2, Nahshon Rand, MD3,

Shmuel Dekel4, Yizhar Floman, MD3; 1Baylor College of Medicine,

Houston, TX, USA; 2Hadassah University Hospital, Jerusalem, Israel;3Israel Spine Center, Tel-Aviv, Israel; 4Tel-Aviv Medical Center, Tel-Aviv,

Israel

BACKGROUND CONTEXT: Severe osteoarthritis of the hip causes

abnormal spinal sagittal alignment and balance as well as a wobbling

gait and is associated with low back pain. Total hip replacement surgery

(THR) is effective in alleviating hip pain and function and improves

gait.

PURPOSE: To assess the clinical and functional effect total hip replace-

ments surgery has upon low back pain.

STUDY DESIGN/SETTING: Prospective clinical study.

PATIENT SAMPLE: Twenty-five consecutive adults scheduled for total

hip replacement surgery due to severe hip joint osteoarthritis were re-

cruited. The 25 study participants included 15 females and 10 males with

a mean age of 67.4 years (range 32–84 years).

OUTCOME MEASURES: A detailed, thorough history and physical

examination of both the hip and spine were conducted (including hip

range of motion and the presence and degree of flexion contracture).

Functional outcome scores were assessed separately for the hips and

for the spine. The Harris Hip Score was used to evaluate hip-related

symptoms in addition to the visual analogue scale specifically for hip

pain. The Oswestry spinal disability score was used to evaluate spine-re-

lated symptoms in addition to the visual analogue scale specifically for

low back pain.

METHODS: Patients included in this study had to demonstrate clinical

evidence of debilitating hip pain, limited range of motion, and radio-

graphic changes characteristic of severe hip joint osteoarthritis. Exclusion

criteria included previous hip and/or spinal fusion or instrumentation sur-

gery. All patients were clinically assessed by an independent internal med-

icine physician including history, physical examination, and functional

scores preoperatively as well as 3 months post-THR using standard vali-

dated outcome measures as described above.

31SProceedings of the NASS 21st Annual Meeting / The Spine Journal 6 (2006) 1S–161S