Canadian Spine Society: 21st Annual Virtual Scientific Conference, Feb. 3, 10, 15, 17 and 24, 2021

s Vol. 64 (4 Suppl 1) July–August 2021 DOI: 10.1503/cjs.012621 SOCIÉTÉ CANADIENNE DU RACHIS 2021 S2 Can J Surg/J can chir 2021;64(4) © 2021 CMA Joule Inc. or its licensors Live Podium Presentations Presentation A1 Abstract 45 Determining clinically important improvement following surgery for degenerative conditions of the spine: analysis of the Canadian Spine Outcomes and Research Network (CSORN) Registry. J. Denise Power,1 Anthony V. Perruccio,1 Mayilee Canizares1, Greg McIntosh,2 Y. Raja Rampersaud,1,3 the CSORN Investigators.2 From the 1Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ont.; the 2Canadian Spine Outcomes and Research Network, Toronto, Ont; and the 3Division of Orthopaedics, Department of Surgery, University Health Network, Toronto, Ont. Background: There is significant variability in clinically important improvement (CII) criteria for spinal surgery that suggest populationand diagnosis-specific thresholds are required to determine surgical success using patient-reported outcome measures (PROMs). This study establishes surgical CII thresholds for 4 common lumbar degenerative spinal diagnoses using accepted anchor-based methodology and commonly used PROMs. Methods: CII analysis was conducted using baseline and 1-year data from participants in the Canadian Spine Outcomes and Research Network (CSORN) registry who underwent surgery for lumbar spinal stenosis (LSS), degenerative spondylolisthesis (DS), disc herniation (DH) or degenerative disc (DD) from 2015 to 2018. One-year CII thresholds were determined for the Oswestry Disability Index (ODI), and back and leg Numeric Pain Rating Scales (NPRS). At 1 year, patients reported whether they were much better, better, the same, worse or much worse compared with before their surgery. This was used as the anchor (improved: ≥ “better” v. not improved: ≤ “same”) to determine CII thresholds for absolute change and percentage change for PROMs using a receiver operating characteristic (ROC) curve approach, with maximization of the Youden index as primary criterion. Correct classification rates were determined. Results: There were 856 participants with LSS (39.1% female, mean age 65.8 yr), 591 with DS (64.1% female, mean age 65.8 yr), 520 with DH (47.5% female, mean age 46.8 yr) and 185 with DD (43.8% female, mean age 50.9 yr). CII for ODI change ranged from –10.0 (DD) to –16.9 (DH). CII for back and leg NPRS change was –2 to –3 for each group. CII for percentage change varied by PROM and pathology group, ranging from –11.1% (ODI for DD) to –50.0% (leg NPRS for DH). Correct classification rates for all CII thresholds ranged from 72.1% to 89.4%. Conclusion: This work quantifies Canadian CII thresholds for the ODI and back and leg NPRS for 4 common lumbar spinal surgery cohorts, with high classification accuracy. Our results suggest that use of generic CII across different diagnoses in spine surgery is not advised. This study establishes the first comprehensive set of responder criteria in Canada for broader application and specificity in clinical and research settings and for surgical prognostic work. Presentation A2 Abstract 31 Cost-utility analysis of microdiscectomy versus non operative management for the treatment of chronic radiculopathy secondary to lumbar disc herniation. Andrew Glennie,1 The Canadian Spine Society is a collaborative organization of spine surgeons advancing excellence in research, education and patient care. Accreditation: This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, approved by The Canadian Orthopaedic Association. Course Objectives: Every year the Canadian Spine Society in conjunction with the Canadian Paediatric Spine Society holds its Annual Scientific Conference. This year, because of the COVID-19 pandemic, our meeting will be totally virtual. The format will be a distributed meeting, hosted on the Canadian Spine Society website, with two-and-a-half-hour sessions every Wednesday during February 2021. Each event will include live paper presentations followed by an online question period. There will be a debate between 2 prominent Canadian surgeons on currently controversial subjects with the opportunity for attendees to respond and vote for a winner. We have engaged 4 international keynote speakers who will address topics related to the overarching themes of the conference. E-posters and case studies will be available for viewing and forum discussions will be held throughout the entire month. Our focus will be on degenerative thoracolumbar pathologies, trauma and spinal cord injury, spinal deformity and cervical myelopathy. Topics from 1 week will also be discussed the following week so attendees will have the opportunity to consider additional aspects. As part of these conversation our speakers will touch on spinal metastatic disease, levering expertise in the time of a health care crisis and gender equality in spine care. The Canadian Paediatric Spine Society will hold a symposium on the surgical management of scoliosis in cerebral palsy. This virtual program offers ample opportunity for sufficient professional contact to share ideas and solutions on a wide range of problems. Our platform has been specifically designed to create a comfortable and extended interaction between clinicians and other interested professionals. It will engage our membership and visitors with our exhibitors in a collegial atmosphere that enhances knowledge sharing and discourages aggressive marketing. Although our Annual Scientific Conference must be a totally virtual experience, it remains the most important spine meeting in Canada. Disclosure of competing interests: Available at www.spinecanada.ca. Content licence: This supplement is Open Access, distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ CANADIAN SPINE SOCIETY 2021 © 2021 CMA Joule Inc. or its licensors Can J Surg/J can chir 2021;64(4) S3 Jennifer Urquhart,2 Prosper Koto,3 Parham Rasoulinejad,4 Keith Sequeira,4 Tom Miller,5 James Watson,4 Richard Rosedale,4 Kevin Gurr,4 Fawaz Siddiqi,4 Chris Bailey.4 From 1Dalhousie University, Halifax, N.S.; 2Lawson Health Research Institute, London, Ont.; 3Nova Scotia Health, Halifax, N.S.; and 4Western University, London, Ont. Background: The objective of this study was to evaluate costutility when comparing early surgery with 6 months of conservative management at the 2-year follow-up point. Methods: A decision tree model was created and parameterized using data from a single-centre randomized controlled trial, augmented with institutional cost data. The cost-utility analysis was from the payer perspective. Cost-effectiveness was assessed using the incremental cost-utility ratio (ICUR) and a threshold of willingness to pay (WTP) of Can$50 000 per quality-adjusted life year (QALY). Sensitivity analysis involved probabilistic sensitivity analysis (PSA) and 1-way sensitivity analyses. The results from the PSA were used to construct the 95% confidence interval (CI) around the estimates. Results: One hundred and twenty-eight patients were included in the study, accounting for potential outcomes and crossover rates between treatment groups. Patients in the surgical group had relatively higher expected costs but had better expected health outcomes. The ICUR was Can$5816 (95% CI $3029–$30 461) per QALY gained. Probabilistic sensitivity analysis demonstrated that the likelihood that early surgical treatment is cost-effective was 0.99 (9848/10 000 from 10 000 Monte Carlo simulations) at the WTP threshold. Conclusion: Early surgery is cost-effective when compared with nonsurgical care. Decision-makers should ensure timely access to surgical care especially in single-payer systems given the extremely favourable cost-utility ratio. Presentation A3 Abstract 44 Impact of undergoing thoracolumbar spine surgery on patient psychosocial health. Samantha Rogers,1 Neil Manson,1,2,3 Erin Bigney,2,4 Amanda Vandewint,2 Eden Richardson,2,5,4 Dana El-Mughayyar,2 Rory McPhee,2,6 Edward Abraham.1,2,3 From 1Dalhousie Medicine New Brunswick, Saint John, N.B.; 2Canada East Spine Centre, Saint John, N.B.; 3Saint John Orthopaedics, Saint John, N.B.; 4Horizon Health Network, Saint John, N.B.; 5Canadian Spine Outcomes and Research Network, Markham, Ont.; and 6University of New Brunswick, Saint John, N.B. Background: The objective of this study was to investigate the impact of thoracolumbar spine surgery on patients’ psychosocial profiles. Methods: This prospective observational study of consecutive thoracolumbar spine surgeries used patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) registry at a single tertiary care centre. Measures of interest were collected from 2014 to 2018 at baseline and 24 months postoperatively. These included the Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), Chronic Pain Acceptance Questionnaire (CPAQ), Multidimensional Scale of Perceived Social Support (MSPSS), the Mental Component Summary (MCS) of the SF-12, and patient expectations for surgery impacts on mental well-being. A repeated-measures analysis of variance (ANOVA) was run (α = 0.05). Patients were then divided into cohorts on the basis of whether or not successful improvement in back pain, leg pain and disability was achieved. The parameters for success were a 30% decrease at 24-month follow-up in numerical rating scores for back pain (NRS-B), leg pain (NRS-L) and Oswestry Disability Index (ODI) score or 24-month follow-up scores below the minimal