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Discussion:
Grade I meningiomas are rare, slowly progressive tumors,
which occasionally originate in the spine. In the setting of diabetic
neuropathy or amyotrophy, these tumors may be difficult to detect. In
such cases, the consequences can be devastating. Early diagnosis is
dependent upon careful history and physical examination, and an
elevated index of suspicion. In our patient, resection of the meningi-
oma resulted in profound improvement in neurologic status and
functional independence.
Conclusions:
Spinal meningiomas in the setting of diabetic neuropa-
thy or amyotrophy may be difficult to detect. Diagnosis requires a wide
differential and a high index of suspicion. Successful recognition can
result in significant neurologic and functional improvement.
Level of Evidence:
Level V
Poster 414:
Transforaminal Epidural Steroid Injection as
Treatment for L5 Radiculitis Caused by Lumbosacral
Transitional Vertebrae with Pseudoarticulation: A
Case Report
Byron J. Schneider, MD, FAAPMR (Vanderbilt University, Nashville, TN,
United States), David Suarez, MD, Matthew Smuck, MD
Disclosures:
Byron Schneider: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 58-year-old woman presented to clinic
reporting multiple months of worsening left-sided dysesthesia in an L5
distribution with associated low back pain. Physical exam was notable
for positive straight leg raise and seated slump tests on the left.
Lumbar x-ray revealed lumbosacral transitional vertebral (LSTV)
anatomy of L5 with pseudoarticulation of the left transitional element
of L5 on the superior aspect of the left sacral ala (Castellvi type II). L-
Spine MRI demonstrated left L5 nerve root impingement in the
extraforaminal space at the medial aspect of the pseudoarticulation.
After inadequate response to NSAIDs and Physical Therapy, we per-
formed a left L5-S1 transforaminal epidural steroid injection (TFESI)
and pseudoarticulation steroid injection. She reported complete
symptom relief for 5 days before gradual return of symptoms. Repeat
injections were performed 2 months later, resulting in 6 months of
complete symptom relief and return to pre-morbid levels of physical
activity. Symptoms then returned and repeat injections were again
performed. Follow up is ongoing.
Setting:
Academic Medical Center.
Results:
Symptom relief after injection (case report, n
¼
1).
Discussion:
The prevalence of LSTV is between 4
e
30%. LSTV is po-
tential cause of back pain arising from the ipsilateral pseudoarticu-
lation, contralateral facet joint, or biomechanical predisposition to
adjacent intervertebral disc pathology. Reports of radicular symptoms
due to LSTV pseudoarticulation are rare. Potential causes of this have
been reported as medial bone spurs causing stenosis of the S1 nerve
root canal and extraforaminal entrapment of the L5 nerve root be-
tween the L5 transitional element and sacral ala. Surgical decom-
pression has been reported as a potential treatment. We believe this
to be the first report of using TFESI to successfully treat lumbar rad-
iculitis caused by LSTV pseudoarticulation.
Conclusions:
TFESI is a potential treatment for lumbar radiculitis
caused by LSTV pseudoarticulation.
Level of Evidence:
Level V
Poster 415:
Treatment of Phantom Limb Pain with Calmare Scrambler
Therapy: A Case Report
Douglas P. Murphy, MD (Virginia Commonwealth Univ Hlth Sys),
Seth A. Haywood, MD, Javier I. Soares, MD
Disclosures:
Seth Haywood: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
Five patients with phantom limb pain
received Calmare treatment secondary to uncontrolled symptoms.
Four of these patients had previously tried other treatment modalities
but their phantom limb pain was refractory to these methods of
management. Previous management included gabapentin, acetamin-
ophen, massage therapy, desensitization techniques and narcotic pain
medications. These patients were all veterans with amputations that
resulted from 1) traumatic upper extremity amputation after IED
blast, 2) right trans-femoral amputation secondary to chronic osteo-
myelitis, 3) right trans-femoral amputation secondary to infected total
knee replacement, 4) right trans-tibial amputation secondary to
trauma in a non-union comminuted fracture, and 5) right trans-radial
amputation secondary to trauma 5 years prior. All patients had sig-
nificant reductions in phantom limb-related pain with no adverse re-
actions to Calmare scrambler therapy.
Setting:
Veterans Affairs Hospital.
Results:
After 5-10 sessions, five patients with previously uncontrolled
phantom limb pain had either complete resolution of phantom limb
pain or a significant decrease in their numeric pain scale from initial
evaluation.
Discussion:
Calmare scrambler therapy is a medical device that uses
synthetic action potentials to stimulate the C-fibers through a non-
pain signal, which is gradually fine-tuned with eventual analgesic ef-
fect. To our knowledge, there is no literature describing the use of
Calmare for phantom limb pain. In our case report, we wish to discuss
5 cases with different comorbidities, etiologies of amputations, loca-
tion of amputation, and duration of symptoms, all of which experi-
enced relief of symptoms from Calmare scrambler therapy.
Conclusions:
Calmare scrambler therapy may be a feasible alterna-
tive for the treatment of phantom limb pain, without the associated
side effects or risks of medications or more invasive interventions.
Level of Evidence:
Level V
Poster 416:
Rehabilitation of Intrapartum Neuromyelitis Optica:
A Case Report
Priya B. Patel, DO (Mt Sinai Hlth Sys), Miguel X. Escalon, MD,
Rachel Santiago, Medical Student
Disclosures:
Priya Patel: I Have No Relevant Financial Relationships To
Disclose
Case/Program Description:
A 31-year-old G2P0020 woman at 20-
weeks gestation presented to an acute rehabilitation unit with
incomplete paraplegia of unknown etiology. MRI spine records showed
multi-level T2 signal changes, suggestive of a myelitis disease process;
however, a diagnosis was not established until lab results from previ-
ous facility showed that patient was positive for NMO. She denied
current or previous symptoms of vision loss or optic pain. Neurology
was consulted and patient had 5 sessions of plasmapheresis off the
unit and then transferred back for inpatient rehabilitation.
Setting:
Inpatient Rehabilitation.
Results:
Goals during rehab extended past the acute setting to ensure
the patient and family were educated of changes that would occur
during pregnancy. Even though the patient was able to stand and walk,
to plan for weight gain during pregnancy, wheelchair training was
conducted. Additionally, she was counseled about nutrition, skin care,
and safe medications to take for NMO related symptoms. On discharge,
the patient and family were confident of the plan to manage NMO as
the pregnancy advanced.
Discussion:
Neuromyelitis optica (NMO) is a CNS autoimmune disease
causing vision loss, eye pain, and the clinical manifestations of
transverse myelitis including arm and leg paralysis, bladder and bowel
incontinence. Other clinical manifestations include severe nausea and
vomiting. Current interventions for pregnant patients are limited and
documented cases demonstrate pregnancy negatively affected the
disease course and worsening disability progression a year after
delivery.
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Abstracts / PM R 9 (2017) S131-S290