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BACKGROUND CONTEXT Sagittal balance in adult spinal deformity is topic of ongoing exploration. Junctional kyphosis and junctional failure are challenging problems whose contributing factors are not entirely understood. A high native pelvic incidence has been shown to be a risk factor for adjacent segment disease. Recent developments in sagittal plane measures include the T1 pelvic angle which was proven to correlate with health-related quality of life scores. PURPOSE To evaluate whether a high preoperative pelvic incidence, postoperative pelvic incidence-lumbar lordosis mismatch, or postoperative T1-pelvic angle is predictive of proximal junctional kyphosis or failure and subsequent revision or persistent pain at long-term follow-up. STUDY DESIGN/SETTING A multicenter, multisurgeon retrospective cohort study. PATIENT SAMPLE All patients who underwent a posterior thoracolumbar fusion with pelvic fixation, with or without interbody fusion, with or without three-column osteotomy between 2010-2019. OUTCOME MEASURES Outcome measures included radiographic evaluation of PJK or PJF, sagittal alignment, adjacent segment disease, revision rate, and back pain needing opiates, pain management, or documentation of surgical revision counseling at or before long-term follow-up. METHODS Patients were separated into cohorts of preoperative pelvic incidence less than or equal to 55° and greater than 55°. -term follow-up ranged from 1 to 8 years post index surgery. Pelvic incidence, lumbar lordosis, T1-pelvic angle, and proximal junctional angle were recorded at preoperative, short term postoperative (less than 3 months) and Long-term postoperative (over 1 year) follow-up. At Long-term follow-up the revision rate and patient symptoms were recorded as well as radiographic parameters. Multivariate statistical analysis is being conducted. RESULTS Preliminary data indicates that 60% of patients with a high native pelvic incidence had evidence of PJK or PJF at or prior to Long-term follow-up. No patients with a low pelvic incidence had junctional kyphosis at Long-term follow-up. Of patients with a T1-pelvic angle over 20°, 55% had evidence of PJK or PJF. The overall rate of revision surgery, continued pain or deformity was 87% in patients with a T1-pelvic angle over 20°. No patients with a T1-pelvic angle less than 20° had PJK or PJF and one patient in this cohort developed symptomatic adjacent segment disease. CONCLUSIONS A native pelvic incidence over 55° may be predictive of Long-term junctional kyphosis and symptomatic adjacent segment disease. A postoperative T1-pelvic angle greater than 20° degrees is associated with continued back pain and revision surgery following thoracolumbar fusions at up to 8 years post surgery. Interestingly, despite correction of PI-LL mismatch within 9° at the short term follow-up, the T1 pelvic angle tended to return to within 10° of the initial preoperative measure in the majority of cases at Long-term follow-up suggesting that the pursuit of sagittal plane correction to meet defined spinopelvic parameters may not account for physiologic kyphosis with increasing age. Data collection is ongoing to meet power analysis and statistical significance criteria. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

To evaluate the role of apparent diffusion coefficient (ADC) as a quantitative means to assess the degree of intervertebral disc (IVD) degeneration contextually within the framework of a widely used Pfirrmann classification rather than in a direct correlation with Pfirrmann grades. DWI and T2-weighted (T2w) of lumbar spine were acquired from nine healthy volunteers (age range 27–62 years, mean age 45 years) with a 3T MR scanner. ADC values were obtained from each of the five lumbar discs via a pixel-by-pixel ADC calculation as well as via region of interest-averaged image intensities. Disc degeneration was assessed by a scoring system via sequential application of Pfirrmann scale and use of intensity ratio of IVD/cerebrospinal fluid in T2w for discs in each Pfirrmann grade to be further separated. A significant correlation was observed between degenerative scores and ADC independent of how ADC was obtained (Spearman’s ρ

BACKGROUND CONTEXT Work disability presents a major burden and stressor at the levels of the individual and society in general. Factors that inhibit or prevent return to work must continually be researched. PURPOSE A study was conducted to examine and define the rates of return to full-time employment for patients not involved in worker's compensation (WC) and to identify modifying factors thereof. STUDY DESIGN/SETTING A retrospective chart review with a prospective IRB approved telephone questionnaire designed to collect pre and postop work history was utilized. Multiple factors were examined that may affect the return to work (RTW) rate of a patient population working full time 3 months prior to surgery (including baseline data such as comorbidities, gender, surgical complexity, age, BMI, social history, ethnicity). PATIENT SAMPLE An IRB-approved retrospective chart review was performed on all surgical patients who underwent spinal surgery from December 2006 to January 2016 in two spinal surgeons’ practices. A total of 1,648 patients were identified with a minimum of 2-year follow-up. After reaching out to 1,088 sequential patients over a 2-year period, 394 called back. Of these, 325 consented to the questionnaire with 69 patients declining. OUTCOME MEASURES Factors examined to affect rate of return to work with 1 year were: procedure type, levels fused, ethnicity, gender, BMI, smoker status, alcohol consumption status, diabetes, heart disease, osteoporosis, anxiety, depression, DVT, previous spine surgery, IV antibiotics, intraoperative and postoperative complications, and infection. METHODS Subgroups within the patient sample showed no significant difference in male-female ratio. Prospective questionaire asked were: status before work, after work, when they returned full time and when RTW to the same job. Minimum phone follow-up was two years postoperatively. Baseline data (date of birth, gender, BMI, preoperative comorbidities, ethnicity, social history, surgery date, surgery type, levels fused, occupation) was obtained by chart review for these patients. The prospective data collecting pre- and postoperative work history along with the retrospective chart review data was analyzed looking for any trends in patients who were working full time 3 months preop and not returning to full time work within a year of surgical date. RESULTS No comorbidity or other correlative factors of RTW were detected. However, a significant difference of RTW rate was noticed between genders. Examining nonretired patients who reported full-time employment within 3 months of surgical intervention, 87 females and 94 males qualified. Only 60% of patients in the female group and 89% in the male group returned to full-time employment within one year. When subdivided by surgical complexity, in noncomplex cases, the rate of return to full-time employment was 59% for females, and 89% for males vs complex cases, where 64% of females and 90% for males returned to work full-time. Both analyses had a power of 99% with p-values less than .05. CONCLUSIONS Our data demonstrated that the return to work rate is significantly lower in female patients undergoing spine surgery, irrespective of the complexity of the surgery. This information may be helpful in pre- and postoperative management. This difference warrants discussion with patients preoperatively. Attitudes of employers towards employees after spinal surgery and the confidence of females after spinal surgery should be further investigated FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The goal of this study was to study the association between solute transport mechanisms in cartilaginous disc endplates and the degeneration of intervertebral discs. Intervertebral disc degeneration is a multi-factorial process. It is suspected that poor nutrient delivery to discs might be a factor leading to degeneration. Several studies suggest that defects in disc endplates could lead to poor transport of nutrients. An imaging technique assessing endplate perfusion could be a valuable tool in investigating disc degeneration. There is currently no universally accepted technique assessing endplate perfusion in vivo.Nine adult patients exhibiting varying levels of intervertebral disc degeneration were included. MRI was used to study the association between blood perfusion in 90 lumbar disc endplates and disc degeneration in 45 lumbar discs. Solute transport mechanism through endplates was assessed indirectly by dynamic contrast enhanced (DCE) MRI. T2-weighted MRI was used for conventional Pfirrmann classification.A positive association was observed between Pfirrmann grades and endplate DCE-MRI enhancement. A differential enhancement between cranial and caudal endplates was also observed, which increased with Pfirrmann grades. This differential enhancement was also dependent on the lumbar level.Increased MRI signal enhancement in the cartilaginous endplates of degenerated discs might indicate damage to the subchondral bone of the vertebral bodies. The endplate enhancement characteristic could aid in understanding the pathophysiology of disc degeneration and planning treatment more effectively.