Researchers From Chennai and Ohio State Share 2017 Wiltse Award

Two research teams are this year’s Leon Wiltse Award winners for the Best Overall Paper at the 2017 International Society for the Advancement of Spine Surgery (ISASS) conference.

Pramod Sudarshan, M.S. and Sajan K. Hegde, M.S., spine surgeons at Apollo Hospitals in Chennai, India, were awarded the Leon Wiltse award for their paper entitled, “Use of Intraoperative Traction in Adolescent Idiopathic Scoliosis: Impact on Concave Apical Screws Density, Curve Correction and Functional Outcomes.”

Drs. Pramod and Hegde used data from consecutive patients operated on at one center and by one surgeon to determine if intraoperative traction helps with pre-instrumentation curve correction and screw insertion in adolescent scoliosis surgery.

The authors wrote, “Group A includes patients [who] were operated during 2008-2011 without intraoperative traction and Group B between 2011-2013 with Skull tong and bilateral skin traction…In group A pre-op mean major Cobb’s angle was 62.8 degree and final correction to 19.5 degree (71% correction). Group B – Pre-op mean major Cobb’s angle was 78.3 degree, which reduced to 48.5 degree (38% correction) on traction film and final correction to 13.5 degree (83% correction). Apical vertebral rotation changed from mean Nash-Moe grade of 2.6 to 2.2 with traction.”

Dr. Pramod told OTW, “Intraoperative traction improved the implant distribution on the concave side which has been shown to have maximum impact in curve correction, measured by the statistically significant difference in concave apical implant density. Though the change in apical vertebral rotation did not reach statistical difference, it helped in instrumentation in majority of the cases.”

Asked about the risks involved, Dr. Pramod told OTW, “Practically, there may be skin issues with traction which have been reported with use of skeletal lower limb traction. We have been able to achieve good intraoperative traction with skin traction alone and have not had any issues in our series. The other worry is regarding alerts in neuromonitoring with traction, which we had in only one case in our large study.”

“Use of intraoperative traction assists by reducing the stress on screws and rods and prevents the need of excessive correction maneuvers by allowing the surgeon to start the case with significant pre-instrumentation correction. Though some centers use it in neuromuscular scoliosis, it is not widely practiced in adolescent scoliosis surgery. Our study refines the indications and techniques in the current era.”

Sohrab Virk, M.D., an orthopedic resident at Ohio State University in Columbus was also awarded the Leon Wiltse award for Best Overall Paper for his novel work regarding inflammation and bone healing for spinal fusion.

Dr. Virk and his co-authors wrote, “Adipokines are secreted by white adipose tissue and have been associated with fracture healing. Our goal was to report the temporal expression of adipokines during spinal fusion in an established rabbit model.”

“Manual palpation scores, radiograph scores and histologic findings showed progression of boney fusion over time. The frequency of fusion by palpation after 4 weeks was 68.75%.”

Dr. Virk commented to OTW, “This is the first study to examine the effect of chemicals secreted by fat cells on spinal fusion. These chemicals are called adipokines and no one to date has determined their role in the carefully coordinated sequence of chemical events to create a solid bony fusion between vertebrae. We believe these results in a rabbit model indicate that fat cells (also known as adipocytes) create an inflammatory environment with these adipokines that may make it harder for obese patients to form solid bony fusions at a local level.”

“The most important clinical findings was that the most studied chemical secreted by fat cells, leptin, may play a vital role during bone formation in spinal fusions at a local level. Furthermore, VEGF [vascular endothelial growth factor] appears to be downstream of leptin expression. This chemical cascade between leptin and VEGF may be an important part of creating a blood supply for spinal fusion masses and may also be critical for signaling cells to form bone.”

“Our study provides information on why the low-grade inflammatory state associated with obese patients may be detrimental to bone healing and forming a solid fusion between vertebrae.”