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152S Proceedings of the NASS 23rd Annual Meeting / The Spine Journal 8 (2008) 1S–191S
P105. Maverick Retrieval Experience Using a Minimally Invasive
Technique in Varying Lumbar Levels
Luiz Pimenta, MD, PhD, Juliano Lhamby, BD, Juliano Fratezi, Sr., MD,
Carlos Arias, MD, Tomas Schaffa, MD, Leonardo Oliveira, MS; Sao Paulo,
Brazil
BACKGROUND CONTEXT: The inclusion of new techniques in the ther-
apeutic arsenal generates new solutions but also new problems. The benefits
of an artificial intervertebral disc include alleviation of pain through restora-
tion of height and stability of the affected spinal segment. In addition, by
maintaining normal or close to normal range of motion, the risk of adjacent
segment degeneration is thought to be lessened. But when revision is neces-
sary, it’s a demanding procedure. Indications to revise the Maverick device
may include implant loosening, malpositioning, displacement, early wear
and infection. Each indication will likely require different preoperative plan-
ning, testing, and strategies. An organized retrieval approach reduces opera-
tive time, minimizes risks, decreases stress and increases the success rate.
PURPOSE: Our strategies for Maverick retrieval have included lateral
(XLIF) removal with subsequent fusion using the same approach.
STUDY DESIGN/ SETTING: maverick TDR revision cases, using a min-
imal invasive XLIF (Extreme lateral interbody fusion) approach through
psoas muscle proving the safety of this access in avoiding vascular struc-
tures and scar tissue. The indications criteria included: persistent lumbar
pain, migration and dislocation of device. Patients ranged in age from
32–50 years old (mean 44.8 y/o). Levels of surgery included, L3/L4 and
L4/L5. VAS and ODI scores were collected to determine clinical outcomes.
PATIENT SAMPLE: 5 disc Maverick prothesis retrival.
OUTCOME MEASURES: VAS and ODI) outcomes clinical assessment
and radiografics mensuraments.
METHODS: five maverick TDR revision cases, using a minimal invasive
XLIF (Extreme lateral interbody fusion) approach through psoas muscle
proving the safety of this access in avoiding vascular structures and scar
tissue. The indications criteria included: persistent lumbar pain, migration
and dislocation of device. Patients ranged in age from 32–50 years old
(mean 44.8 y/o). Levels of surgery included, L3/L4 and L4/L5. VAS and
ODI scores were collected to determine clinical outcomes.
RESULTS: The five patients were successfully revised with fusion proce-
dures by a minimally invasive XLIF approach complemented with pedicle
screws without surgical complications. Mean surgical time was 89,4 min-
utes; mean blood loss was!50 ml, and all were outpatient surgeries. All pa-
tients after re-operations showed improvements in the clinical (VAS and
ODI) outcomes assessment, with solid fusion after two years follow-up.
CONCLUSIONS: Retrieval surgery in failed TDR is a demanding proce-
dure, often technically difficult, and carries an incidence of morbidity.
Therefore, to achieve the best results, a meticulous plan should be made
and surgically executed with care and precision. The XLIF procedure is
a safe and effective strategy for minimally disruptive Maverick TDR
removal at the L3/L4 and L4/L5 levels. Careful and appropriate patient
selection is essential in ensuring optimal outcomes.
FDA DEVICE/DRUG STATUS: Maverick Disc Prosthesis: Approved for
this indication.
doi:10.1016/j.spinee.2008.06.351
P106. Severely Polytraumatized Patients with and without Spinal
Injury Presenting to a Level I Trauma Institution
Albert Yee, MD, FRCSC1, Edward Lansang, Jr., MD2, Olivia Murnaghan3,
Iris Weller1, Yigal Bronstein, MD4, Michael Ford, MD1, Joel Finkelstein,
MD1; 1University of Toronto, Toronto, Ontario, Canada; 2Sunnybrook
Health Sciences Centre, Toronto, Ontario, Canada; 3McMaster University,
Hamilton, Ontario, Canada; 4Haddasa Medical Center, Beit-Shemesh,
Israel
BACKGROUND CONTEXT: Spinal trauma can have a significant neg-
ative effect on the morbidity, mortality and other outcomes of polytrauma
patients. There is limited literature whether spinal trauma adversely affects
the outcome of severely polytraumatized patients.
PURPOSE: The purpose of this study is to determine whether there are
differences in early hospital outcomes, morbidity and mortality in poly-
traumatized patients with Injury Severity Score (ISS) O/5 14, with or
without spinal fractures.
STUDY DESIGN/ SETTING: This is a case-control study conducted at
a Level 1 Trauma institution.
PATIENT SAMPLE: Polytraumatized patients with spinal injury and ISS
O/5 14 admitted between 1998 and 2005 were included. Age-, sex-, and
ISS-matched controls were identified from the Sunnybrook trauma
registry.
OUTCOME MEASURES: Outcomes that were measured included
length of ventilation, length of ICU stay, length of hospital stay, number
of operations and mortality.
METHODS: The Sunnybrook trauma registry was used to identify con-
secutive polytraumatized patients with spinal injury (ISSO14) admitted be-
tween 1998–2005. A matched control group (age, gender, ISS) without
spinal injury was assembled. Data was then collected from the medical
charts. The data was organized tabulated in a spreadsheet and subsequently
analyzed. Patient demographics were also tabulated for both groups. For
the spine group, the neurologic injury, fracture grade and treatment data
were also gathered.
RESULTS: There were a total of 290 patients (151 spinal, 139 control).
Spine injured patients spent more days ventilated (5.1d vs 2.4d) and expe-
rienced both a longer ICU (10.4d vs. 5.4d) and hospital stay (25.7d vs
16.2d). They also underwent more operations (1.2 vs 0.8) and more surgi-
cal procedures (1.5 vs 1.2). There was a trend toward greater mortality
(15% vs 9%) in the control group. The mortality rates of patients with
moderate-to-severe neurology (frankel A,B), mild-and-no-neurology
(frankel C,D,E) and the control were also compared (14% vs 8% vs
15%). Similarly, a comparison of mortality rates of low grade (AO grade
A) spine injury, high grade (AO grade B,C) spine injury and control group
was also done (8% vs 10% vs 15). Within the spine group, neurologic in-
jury occurred in 31% Fracture severity by AO grade showed 44% grade A,
29% grade B and 27% grade C. Thirty five percent of patients were treated
surgically. A higher AO-grade was associated with greater neurologic dys-
function, higher surgical rate and longer hospital stay. Neither Frankel
grade (A to E) nor AO-grade (A,B,C) correlated with early acute hospital
mortality.
CONCLUSIONS: Patients presenting with spinal injury in the face of
severe polytrauma appear to have a longer ICU stay and requirement for
ventilation when compared to those patients without spinal injury. The in-
cidence of neurologic injury and multilevel injuries in the spine group are
a reflection of higher energy trauma typically sustained by severely poly-
traumatized patients. As such, a high index of suspicion is warranted in the
evaluation of spinal injury and in clearance of the spine in patients present-
ing with an ISSO14.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include
any applicable devices or drugs.
doi:10.1016/j.spinee.2008.06.352
P107. Radiographic Histologic and Specimen Evaluation of Cervical
Nitinol Staples in a Goat Model
Robert Johnson, MD1, Karl Swann, MD1, Albert Sanders, MD1,
Matthew Swann2; 1San Antonio, TX, USA; 2Washington, DC, USA
BACKGROUND CONTEXT: Surgery may be indicated for cervical de-
generative disc disease in individuals that have failed conventional medical
management, and usually involves anterior cervical discectomy and fusion
with a plate/screw construct. A long term complication is pseudoarthrosis.
The pseudoarthrosis rate has been reported as 3% to 26%. Advances in
nitinol technology have made shape-memory nitinol more attractive for
orthopedic applications. Nitinol is a Nickel-Titanium alloy that can change