Recent Spine Podium Presentations
Jonathan N. Sembrano, MD
University of Minnesota Medical
School, Minneapolis VA Medical
The American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting, held March
9-13, 2010, was a big meeting with a lot to offer the spine subspecialist. Included in the
program were symposia, instructional course lectures, podium paper presentations, poster
and scientific exhibits, and technical exhibits.
Spine specialty programming included 60 podium presentations divided among four
sessions, five scientific exhibits, 60 poster exhibits, 18 instructional course lectures and
two symposia. To cap things off, the Federation of Spine Associations (FOSA) prepared a
full specialty day of lectures and debates on important spine topics. Below, the podium
presentations of original spine research are summarized.
BMP and Fusion
In the first podium session, five papers explored issues surrounding rhBMP- 2 utilization.
In 1,037 cases, Glassman et al reported a complication rate for BMP- 2 similar to ICBG.
From the same institution, however, Owens et al found a 3.5% neurologic complication
rate in 204 TLIF cases that utilized BMP- 2. Gogia et al used BMP- 2 in 27 pediatric cases
without any significant complications. Sampat et al reported retroperitoneal seromas after
BMP- 2 implantation in anterior lumbar interbody fusion (ALIF).
The increasing utilization of the transpsoas appoach prompted two anatomic studies
of the relationship between the lumbar plexus and the psoas muscle Davis et al noted
that the femoral nerve is at greatest risk when exposing the L4-5 disc space. The posterior retractor blade may compress the femoral nerve against the L5 transverse process.
Shanti et al characterized safe zones for the transpsoas approach in relation to the neural
structures at every disc level.
Glassman et al found lumbar fusion to be cost effective at five years with a cost per
QALY (quality-adjusted life-year) of $33,018. Mostafa et al concluded that pedicle subtraction osteotomy (PSO) more effectively corrects post-traumatic kyphosis than anterior
corpectomy. Cheh et al reported a 23% failure rate of indirect decompression with ALIF
and percutaneous pedicle screw fixation in relieving symptoms related to spinal stenosis.
Hohl et al reported a 1.3% incidence of pulmonary embolism with 0% mortality in 2,658
surgeries for degenerative lumbar spine conditions. Santos et al found that surgeon
perception of navigated pedicle screw placement was highly accurate for the thoracic
and lumbosacral spine but not for the cervical spine. In this study, surgeon perception
was a composite of tactile feel using a ball-tipped probe and information gleaned from
the navigation screen. Mikhael et al did not find any difference in infection rate between
nonirradiated allograft and autograft for spine fusion. Schoenecker et al reported that
aprotinin inhibited bone matrix mineralization, while aminocaproic acid and tranexamic
acid did not. Schoenecker and colleagues studied the impact of three antihemorrhagic
agents in bone formation and found that aprotinin inhibited bone matrix mineralization, while aminocaproic acid did not. Koptan et al reported their successful results in
performing unilateral transforaminal lumbar interbody fusion (TLIF) for postdiscectomy