S334 2017 Annual Meeting of the British Scoliosis Society / The Spine Journal 17 (2017) S321–S335
weighing benefits and risks of surgery. Deformity correction can be per-
formed using a meticulous technique and this has produced and maintained
in our series a satisfactory outcome.
https://doi.org/10.1016/j.spinee.2017.10.057
0080. The Efficacy of Multi-Modal Intra-Operative Spinal Cord
Monitoring (IOM) in Preventing Neurological Injury during Spinal
Deformity Surgery
Athanasios Tsirikos, Lindsay Henderson, Andrew Duckworth,
Ciara Michaelson; Scottish National Spine Deformity Centre, Royal
Hospital For Sick Children, Edinburgh, United Kingdom
OBJECTIVE: The purpose of this study was to present the diagnostic char-
acteristics of multi-modal IOM in spinal deformity surgery. Also, to define
and categorize the neuro-monitoring events, as well as develop an algo-
rithm of action.
MATERIALS-METHODS: We reviewed 1011 consecutive patients (707
female; 304 male) who underwent deformity correction using standardized
peri-operative care, cortical/cervical SSEPs and upper/lower limb transcranial
electrical MEPs under a single surgeon. Mean age at surgery was 14.2 years
(range: 10–23.3). We categorized IOM events as true, transient true and false
positive or negative. Diagnostic performance criteria were calculated.
RESULTS: Most common diagnosis included adolescent idiopathic sco-
liosis in 654 (65%) patients. We identified 3 true positive monitoring events
occurring in 2 patients (0.20%), 6 transient true positive (0.59%), and 8 tran-
sient false positive events (0.79%). There were no false negative events and
no patient had post-operative neurological deficits. Our multi-modal IOM
technique had sensitivity 100%, specificity 99.2%, positive predictive value
50% and negative predictive value 100%. The frequency of true or tran-
sient true positive events was significantly higher (p=.036) in Scheuermann’s
kyphosis (3/84 patients, 3.6%) compared to adolescent idiopathic scoliosis
(4/654 patients, 0.61%).
CONCLUSIONS: Multimodal IOM is highly sensitive and specific for spinal
cord injury. This technique is reliable to assess the condition of spinal cord
during major spinal deformity surgery and an algorithm of intra-operative
action was developed.
https://doi.org/10.1016/j.spinee.2017.10.058
0081. Does Magnesium Sulphate Infusion in the Perioperative Period
Reduce the Requirement for Postoperative Opioid Analgesia in
Posterior Surgical Correction of AIS
Peter Minnis1,2, Jamie East1,2, Jwalant Mehta1, Egidio Da Silva1; 1Royal
Orthopaedic Hospital NHS Foundation Trust, United Kingdom;
2
University of Birmingham, United Kingdom
BACKGROUND TO THE STUDY: Postoperative muscle spasm is an im-
portant cause of post-operative pain. Magnesium is an effective calcium
antagonist and is able to attenuate calcium-induced muscle contraction re-
ducing muscle spasm. This is a retrospective study that explores the use of
magnesium sulphate as an analgesic adjunct in patients undergoing scolio-
sis correction.
MATERIALS AND METHODS: We identified 31 patients undergoing pos-
terior scoliosis correction over a 6-month period. Due to different anaesthetic
practices, we identified 10 patients that had received perioperative magne-
sium sulphate transfusion and 20 patients that did not. All the patients received
total intravenous anaesthesia, underwent a posterior correction of the struc-
tural curves with multi-modal spinal cord monitoring. The plasma levels of
magnesium were normalized in the post-operative period. The two groups
were matched by age, sex, pre and post operative Cobb angles, correction
and flexibility indices and the number of levels instrumented.
The mean age of the patients that received magnesium was 15.3 years and
that did not was 15.27 years. Eight of 10 patients in the magnesium group
and 19/21 in the non-magnesium group were females.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately
reporting disclosure and FDA device/drug status at time of abstract submission.
The opiate medications were converted by an opiate converter formula to
determine the “total equivalent dose.”
RESULTS: We found that on average the patients in magnesium group spent
1.2 days fewer (6.2 days vs 5 days, p=.0125*) in hospital recovering (figure
A), required 120 mg less oral morphine (372 mg vs 252 mg, p=.05) (figure
B) required 30% less additional adjuvant medication and the average intake
of gabapentin was 1067 mg in the magnesium group compared with 2838 mg
in the non magnesium group (p=.117).
CONCLUSION: Our findings suggest that the use of magnesium sul-
phate shows an encouraging trend in reducing patients’ postoperative opioid
analgesic requirements and length of the hospital stay. We plan to use this
study as a pilot towards a prospective study.
https://doi.org/10.1016/j.spinee.2017.10.059
0082. Anterior Column Reconstruction in Primary Adult
Degenerative Scoliosis Correction Surgery: Restoring Lordosis and
Achieving Indirect Decompression With Minimally Invasive Lateral
Cages
Robert Lee, Michael Mokawem; Royal National Orthopaedic Hospital,
Stanmore, United Kingdom
BACKGROUND: Patients with degenerative scoliosis often present with
leg pain, back pain and issues with sagittal balance. Complications follow-
ing open correction surgery can be high and sagittal balance correction poor
using a posterior only technique. We present a case series demonstrating that
multiple anterior cages inserted via a minimally invasive lateral or anterior
technique is an effective way of correcting the coronal deformity and re-
storing sagittal balance. Additionally, it provides indirect decompression of
neural structures.
METHODS: Retrospective review of prospectively collected data in a single
surgeon case series of 48 patients with adult degenerative scoliosis. Previ-
ous spinal fusion surgery excluded patients. Surgery: Anterior cages inserted
via a minimally invasive lateral or anterior technique (via a single or mul-
tiple stage approach). Outcome measures: (i) Radiographic. Pre and post-
operative parameters: Lumbar lordosis (LL), Pelvic Incidence-Lumbar Lordosis
mismatch (PI-LL), Sagittal Vertical Axis (SVA), Pelvic Tilt (PT) and Cobb
angle. (ii) Patient reported outcome measures. VAS Back, VAS leg, EQ-
5D, EQ-5D VAS, ODI, Roland Morris Disability Score (RMD). Minimum
follow-up: 6 months.
RESULTS: Forty-eight patients (30 females and 18 males). Average age:
67.0yrs (54.9yrs - 83.4yrs). Positive sagittal balance in 31 patients. 42 Cases
purely MIS and 6 cases hybrid with open posterior fusion. A total of 128
lateral cages were inserted with 1 level in 7 patients, 2 levels in 14 pa-
tients, 3 levels in 15 patients and 4 levels in 12 patients. Distribution of levels:
L1/2- 12 cages, L2/3 – 34 cages, L3/4 – 44 cages, L4/5 - 38 cages. Average
postoperative scores showed improvement of SVA 90.1 to 35.3 mm, PI-LL
26 to 2 degrees and Cobb angle 23 to 5 degrees. Average 6 month
outcome scores were: VAS back 8 to 3, VAS leg 8 to 2, EQ-5D 0.257 to
0.720, EQ-5D VAS 44 to 74, ODI 64 to 28, RMD 16 to 11. These scores
were maintained in patients reaching 1 year and 2 year follow-up
marks.
CONCLUSION: The use of minimally invasive lateral cages in pri-
mary adult degenerative scoliosis surgery is an effective surgical strategy
with good restoration of lordosis and improvement in both leg and back
pain.
https://doi.org/10.1016/j.spinee.2017.10.060
0083. Reliability of Preoperative Surgical Planning Software in
Predicting Postoperative Alignment in Patients Undergoing
Minimally Invasive Multilevel Anterior Column Reconstruction for
Positive Sagittal Balance Deformity
Robert Lee, Michael Mokawem; Royal National Orthopaedic Hospital,
Stanmore, United Kingdom