Background The majority of the 700,000 osteoporotic vertebral compression fractures (VCFs) that occur annually in the United States affect women. The total treatment costs exceed $17 billion and approximate the total costs of breast cancer ($13 billion) and heart disease ($19 billion). Balloon-assisted percutaneous vertebral augmentation with bone cement (kyphoplasty) reportedly reduces VCF-related pain and accelerates return of independent functional mobility. Kyphoplasty may decrease overall cost of VCF treatment costs by reducing use of posttreatment medical resources. Questions/purposes We evaluated complications, mortality, posthospital disposition, and treatment costs of kyphoplasty compared with nonoperative treatment using the Nationwide Inpatient Sample database.Methods We identified 5766 VCFs (71% female) in patients 65 years of age or older with nonneoplastic VCF as the primary diagnosis in nonroutine hospital admissions; 15.3% underwent kyphoplasty. Demographic data, medical comorbidities, and fracture treatment type were recorded. Outcomes, including complications, mortality, posthospital disposition, and treatment costs, were compared for each treatment type. Results Women were more likely to be treated with kyphoplasty than were men. Patients undergoing kyphoplasty had comorbidity indices equivalent to those treated nonoperatively. Kyphoplasty was associated with a greater likelihood of routine discharge to home (38.4% versus 21.0% for nonoperative treatment), a lower rate of discharge to skilled nursing (26.1% versus 34.8%) or other facilities (35.7% versus 47.1%), a complication rate equivalent to nonoperative treatment (1.7% versus 1.0%), and a lower rate of in-hospital mortality (0.3% versus 1.6%). Kyphoplasty was associated with higher cost of hospitalization (mean $37,231 versus $20,112).

Objective 1) To describe a simplified multidisciplinary grading system for the most clinically relevant lumbar spine degenerative changes. 2) To measure the inter-reader variability of non-radiologist spine experts in interpreting a consecutive series of lumbar spine MRI utilizing the classification. Methods A multidisciplinary and collaborative standardized grading of spinal stenosis, foraminal stenosis, lateral recess stenosis, and facet arthropathy was developed. Our institution’s PACS was searched for 50 consecutive patients who underwent non-contrast MRI lumbar spine for chronic back pain, radiculopathy, or symptoms of spinal stenosis. Three fellowship-trained spine subspecialists from neurosurgery, orthopedic surgery, and physiatry interpreted the 50 exams utilizing the classification at the L4-L5 and L5-S1 levels. Inter-reader agreement was assessed with Cohen’s kappa coefficient. Results For spinal stenosis, the readers demonstrated substantial agreement (k = 0.702). For foraminal stenosis and facet arthropathy the three readers demonstrated moderate agreement (k = 0.544, and 0.557, respectively). For lateral recess stenosis, there was fair agreement (k = 0.323). Conclusions A simplified universal grading system of lumbar spine MRI degenerative findings is newly described. Utilization of this multidisciplinary grading system in the assessment of clinically relevant degenerative changes revealed moderate to substantial agreement among non-radiologist spine physicians. This standardized grading system could serve as a foundation for interdisciplinary communication.

Context: Cigarette smoking is an established risk factor for pseudarthrosis and poor clinical outcomes in lumbar spine fusion. Recombinant human bone morphogenetic protein (rhBMP) was found to be as good as or better than iliac crest bone graft (ICBG) in achieving fusion.Study Design and Results: This study aimed to determine if the use of rhBMP in lumbar spinal fusion can overcome the negative impact of cigarette smoking. Patients who were part of a randomized, nonblinded trial of an rhBMP-2 matrix (AMPLIFY rhBMP-2 Matrix, Medtronic, Memphis, TN) or ICBG for single-level, instrumented posterolateral lumbar spinal fusion were retrospectively stratified by preoperative smoking status. Of the 148 patients in the study, 42 were smokers and 106 were nonsmokers. Clinical outcome was measured 2 years after surgery using the validated Oswestry Disability Index (ODI) and Medical Outcomes Study Short Form-36 (SF-36). Fusion was defined as bilateral bridging bone on plain radiographs with less than 3°translation and less than 5°angulation on dynamic lateral lumbar radiographs and also was compared between groups. At the 2-year evaluation, fusion was achieved in 100% of nonsmokers using rhBMP-2 and 94.1% of nonsmokers using ICBG; for smokers, 95.2% achieved fusion using rhBMP-2 whereas 76.2% achieved fusion using ICBG. The difference between smokers and nonsmokers was statistically significant for the overall rate of fusion and the rate of fusion using ICBG. The difference in fusion between smokers who received rhBMP-2 and smokers who received ICBG was not statistically significant. The clinical outcome scores improved significantly for all patients but were better for nonsmokers than smokers.Conclusions: The study suggests that the use of rhBMP-2 may overcome the detrimental effects of cigarette smoking in patients having single-level, instrumented posterolateral lumbar spinal fusion. The increased rate of fusion does not appear to enhance the clinical outcome as measured by the ODI and SF-36.