RESULTS: Radiographic and clinical follow-up of 2 years or more were

available for 51 of 57 consecutive patients (96% follow-up). The mean age

was 51.7 years (range 32.7 to 77.5). Follow-up was 2.0 to 7.4 years (mean

4.0). There were 38 primary and 13 revision procedures. The diagnoses

were: adult idiopathic scoliosis, n540 (78.4%), degenerative lumbar sco-

liosis, n57 (13.7%), lumbar flatback with sagittal imbalance, n53

(5.9%), and transition syndrome, n51 (2.0%). The mean segmental lordo-

sis (L3 to S1) of the overall cohort increased significantly with surgery

from 41.0 to 46.4 degrees (p5.0003). The increased segmental lordosis

was maintained at 2-year (46.5�) and final (45.3�) follow-up. In the 23 pa-

tients with less than 40 degrees of segmental lordosis preoperatively (range

12�–39�) there was a statistically significant increase in L3-S1 lordosis

with surgery from 30.5 to 44.3 degrees (p!.0001). This was maintained

at 2-year (41.6�) and final (42.0�) follow-up. The subset of patients who

had cages placed at all 3 distal levels (n524) had a significant increase

in segmental and total lordosis. There was no statistically significant loss

of either segmental or total lordosis over time in this subgroup. The mean

Oswestry Disability Index improved significantly (p!.0001) between the

preoperative (26.5) and final follow-up (14.4) evaluations.

CONCLUSIONS: Contrary to past reports, we did not find loss of lordosis

in the distal lumbar spine of adult scoliosis patients when titanium mesh

cages were protected with pedicle screws. In fact, segmental lumbar lordo-

sis was increased significantly and was maintained in these patients.

FDA DEVICE/DRUG STATUS: Titanium cages: Not approved for this

indication.

CONFLICT OF INTEREST: Authors (BK, LL) Grant/Research Support:

Medtronic Sofamor Danek; Author (LL) Consultant: Medtronic Sofamor

Danek.

doi: 10.1016/j.spinee.2006.06.313

P106. Surgical Treatment of Brucellosis of the Thoracic and Lumbar

Spine

Alexander Hadjipavlou, MD1, Michael Tzermiadianos, MD2,

Pavlos Katonis, II3, Achilleas Gikas, MD3, Theodoros Tosounidis, MD3;1University of Crete, Heraklion, Crete, Greece; 2Loyola University of

Chicago, Maywood, IL, USA; 3University of Crete, Crete, Greece

BACKGROUND CONTEXT: Surgical treatment is considered as the last

resort in spinal brucellosis because of the usual good response to antibi-

otics. However, many patients respond only partially or temporarily and

some reports indicate that 40% of patients require several courses of treat-

ment. The role of surgery in spinal brucellosis remains controversial.

PURPOSE: To evaluate the results of early surgical intervention, either

by means of minimally invasive surgery, or open surgery when severe

neurocompression occurs.

STUDY DESIGN/SETTING: Retrospective review.

PATIENT SAMPLE: Ten consecutive patients were surgically treated for

spinal brucellosis of the thoracic and lumbar spine.

OUTCOME MEASURES: Clinical outcomes were evaluated with pain

diagrams and Visual Analogue Score for pain. Assessment was performed

at 1, 3, 6, 9, 12 months and every 6 months thereafter. Clinical sequelae

were classified at the latest follow-up visit as: normal, no pain or neurolog-

ical deficits; mild, no neurological deficits but pain with exercise that does

not interfere with work; moderate, pain interfered with work or milder

motor or sensory deficits; and severe, permanent and excruciating pain or

motor deficits.

METHODS: Patients with spondylodiscitis without epidural abscesses

(n53) underwent transpedicular discectomy and drainage. Epidural ab-

scesses in the lumbar area, caused by spondylodiscitis (n53), spondylitis

(n52), and discitis with infected disc herniation (n51), were drained via

posterior approach, combined with posterolateral fusion in two spondylo-

discitis cases, and discectomy in the patient with herniated disc. One pa-

tient presented a pathologic fracture and neurocompression (Frankel C

paraparesis) and was treated with anterior corpectomy and reconstruction.

Antibiotic treatment was given for 3-9 months. Mean follow-up period was

32 months (range, 12 to 68 months).

134S Proceedings of the NASS 21st Annual Meeting / The Spine Journal 6 (2006) 1S–161S

P105. Comparison of Radiographic Fusion Rates Between One Level

and Two Level Stand-Alone ALIFs

Mark Rosenthal, MD1, Richard Henrys, MD2; 1Orthopaedic Specialty

Center, Baltimore, MD, USA; 2Miami, FL, USA

BACKGROUND CONTEXT: One level stand-alone anterior lumbar in-

terbody fusions (ALIF) have been shown to be successful in treating dis-

cogenic pain. This procedure results in acceptable fusion rates (Sasso et

al., Spine 2004). There is little data on two level ALIF without posterior

stabilization. Kuslich et al. (Spine, 1988) reported on ALIFs and showed

a 92% success rate for one level versus 78% for two level. We are not

aware of other studies which compare the fusion rate of one versus two

levels.

PURPOSE: The purpose of the present study is to retrospectively compare

the radiographic union rates between one level and two level stand-alone

ALIFS.

STUDY DESIGN/SETTING: The current study is a retrospective review

of radiographic fusion status.

PATIENT SAMPLE: Patients with single or two level symptomatic

degenerative disc disease seen between January 1998 and May 2004 were

entered into the study. Diagnosis was established with clinical findings, di-

agnostic imaging, and discography. Surgical candidates failed at least 6

months of nonoperative treatment. Patients who had previous fusion at

the symptomatic or adjacent levels were excluded. There were 20 patients

undergoing single-level ALIF (8 females, 12 males, mean age 38.9) and 20

patients undergoing two level ALIF (7 females, 13 males, mean age 43.3;

18–59). There were no significant differences between one level and two

level stand-alone ALIF groups concerning number, age (p5.135), male:fe-

male (p5.744), or radiographic follow-up (p5.688). The first 15 patients

had channel discectomies with end plate reaming via transperitoneal ap-

proach, with placement of threaded cortical bone dowels. All remaining

cases were done via retroperitoneal approach, with en-bloc disc excision

and placement of titanium threaded cages. Initial cases were done with au-

tologous iliac crest bone graft, some augmented with demineralized bone

matrix. After June 2002, rhBMP was used solely as graft substitute. All

patients were braced postoperatively.

OUTCOME MEASURES: Radiographs were evaluated to determine

fusion status.

METHODS: Radiographs were obtained at a minimum of 6 weeks, 3

months, and 1 year, with dynamic films at 1 year. For the one level ALIF

group, the average radiographic follow-up was 16.9 months (11-57), and

for the two level ALIF group 15.7 months (8-35). The radiographic criteria

for determining fusion included bridging bone connecting adjacent verte-

bral bodies either through implants or around implants, less than 3� angu-

lar motion, less than or equal to 3 mm translation, and absence of lucency

around more than 50% device-host interface. Statistical methods for con-

tinuous variables: p values determined via Student t test. For categorical

variables, p values determined via c2 test.

RESULTS: Results showed a fusion rate of 95% (19 of 20) for single-level

patients, but only 55% (11 of 20) for two level ALIFs (p50.0034). There

was no statistical difference between en-bloc versus channel discectomy,

cortical dowel versus metal cage, and use of BMP versus autologous graft.

CONCLUSIONS: The current study, which looks only at fusion rates,

seems to indicate that two level stand-alone ALIF does not have as

successful a fusion rate as single-level ALIF. Surgeons should consider

supplemental fixation for such cases.

FDA DEVICE/DRUG STATUS: InFuse: Approved for this indication; LT

cage: Approved for this indication; Interfix cage: Approved for this

indication.

CONFLICT OF INTEREST: Author (MR) Consultant: Medtronic

Sofamor Danek.

doi: 10.1016/j.spinee.2006.06.314