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presenting pain was debilitating to the point where he had been bed-
bound and was unable to attend school. He was unable to be fitted for a
brace due to an ostomy that was recently placed. Recent imaging
showed acute compression fractures in the lumbar spine with chronic
fractures in all vertebral bodies. The patient was continued on previ-
ously scheduled methadone and hydromorphone PRN with a planned
weaning schedule as well as starting baclofen.
Setting:
Tertiary University Pain Management Clinic.
Results:
The patient followed up every 3 months for the next 18 months.
He had significant pain reduction on the prescribed regimen initially. The
baclofen dose was titrated up to 10mg TID and he only needed a rare use of
hydromorphone. By 18 months we weaned the patient off of the metha-
done. He is currently only using 10mg of baclofen at bedtime.
Discussion:
Management of compression fractures in the pediatric
population is complicated with little consensus in the current litera-
ture. Conservative medical management is preferred, but due to the
significant pain it is difficult to manage the pain with non-opioid
analgesic medications. Other options for severe cases include verte-
bral augmentation and possibly inhaled calcitonin.
Conclusions:
Management of vertebral compression fractures in pe-
diatric patients is challenging but a multi-modal treatment plan is
most reasonable. More aggressive treatments option such as opioids or
vertebral body augmentation should be used for refractory cases.
Level of Evidence:
Level V
Poster 439:
Cerebrospinal Fluid Leak and Foot Drop Following
Laminectomy: A Case Report
Brian Pekkerman, DO (SUNY Downstate, Brooklyn, NY, United States),
Bhavi Patel, DO, Margarita m. Nunez, DO
Disclosures:
Brian Pekkerman: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
A 63-year-old man with history of motor
vehicle accident causing disc herniation at L4-L5 and protrusion of L2-
L3 creating non-radicular low back pain. Patient underwent two spinal
discectomies resulting in worsening symptoms and newly developed
electrical shooting into bilateral lower extremities. Symptoms were
attributed to ongoing spinal stenosis secondary to disc herniations and
a synovial cyst. Surgeon performed L2-L3 laminectomy for synovial
cyst removal. In the recovery room patient experienced sudden left
foot drop, severe headache, and decreased sensation of bilateral legs.
Patient emergently returned to OR for evaluation and repair of dural
tear with cerebrospinal fluid (CSF) leak. Patient presented to rehab
floor with significant left foot drop, 1/5 strength with dorsal/plantar
flexion, numbness below bilateral patella, and ongoing radicular back
pain. In addition, patient complained of inability to ambulate,
neurogenic bladder, and difficulty controlling stool.
Setting:
Tertiary Care hospital.
Results:
On the rehab floor pain became controlled with medication
adjustments, AFO given for foot drop and rolling walker provided for
ambulation. Patient was discharged home with supervision in all ac-
tivities and ambulated 300 feet with rolling walker.
Discussion:
Dural rupture and CSF leak is a documented risk of spinal
surgery, with complication rates ranging from 1%-17%. It is important
to note the variety of symptoms in the case above. Commonly CSF
leaks cause headache, nausea and dizziness. This patient presented
with foot drop, weakness, and numbness, which are not consistent
with a dural puncture. This can be attributed to nerve root damage
and has significant consequences on treatment and prognosis.
Conclusions:
Neurological complications following CSF leak are rare
but possible. When such complications occur, a rehabilitation physi-
cian’s expertise in therapy prescriptions, orthotic and assistive devices,
pain control and management of expectations are crucial for patients
return to function and achieving independence in their daily life.
Level of Evidence:
Level V
Poster 440:
Radiofrequency Ablation as Effective Treatment for
Trigeminal Neuralgia: A Case Report
Michael D. Smith, OMS-III (Nova Southeastern University College of,
Orlando, FL, United States), Robert E. Kent, DO, MHA, MPH, FAAPMR,
Daniel Leary, Medical Student
Disclosures:
Michael Smith: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
Patient is a 53-year-old woman with
multiple sclerosis who came under our care for pain management for a
9-year history of severe right sided trigeminal nerve pain. She de-
scribes the pain as a constant shooting pain located on the right side of
her face in V2 & V3 distributions. Her symptoms have been treated
with opioid analgesics, amitriptyline, gabapentin, pregabalin, and
baclofen, and has also underwent multiple trigeminal nerve blocks, all
which offered little permanent effect for her pain. Right-sided tri-
geminal radiofrequency ablation was performed after successful tri-
geminal nerve block. Before procedure, she reported her pain at 9/10.
Procedure was tolerated without complications.
Setting:
Outpatient medical clinic and surgical center.
Results:
Patient tolerated procedure without complications. One
month after she reported a 50% reduction in pain associated with her
trigeminal neuralgia.
Discussion:
It is estimated that 90% of trigeminal neuralgia cases are
due to vascular compression at the trigeminal nerve root. Treatment
for refractory trigeminal neuralgia often includes surgical vascular
decompression of affected nerve root. These surgeries can be
dangerous due to the nature of the procedure and complex craniofa-
cial anatomy. In many, trigeminal nerve blocks provide relief, but
results may only last hours. Radiofrequency ablation can provide a safe
and effective option to decrease pain and lessen the need for anal-
gesic medications in these individuals.
Conclusions:
Radiofrequency ablation of trigeminal nerve is a safe
and effective treatment for refractory trigeminal neuralgia where
conservative measures have failed.
Level of Evidence:
Level V
Poster 441:
Out With the Old, in with the Nuvaring . Pudendal
Neuralgia: A Novel Complication of the Nuvaring :
Case Report
Roberta Lui (Albert Einstein Col of Med), Anna M. Lasak, MD
Disclosures:
Roberta Lui: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
We present a healthy 23-year-old woman
who is referred by her uro-gynecologist for evaluation of severe pain in
the vulvar area associated with dysuria, dyspareunia, allodynia, and
pain worse with sitting. She had been previously using the Nuvaring ,
a plastic vaginal ring that releases ethinylestradiol and etonogestrel,
for contraception until she self-discontinued after 10 months use due
to acute development of pain. She tried topical lidocaine and steroid
creams but pain persisted. Work up by outside physicians including
testing for sexually transmitted diseases, urinary tract infection, and a
Pap smear all came back negative. Pelvic examination in our office
revealed erythema, swelling, and exquisite tenderness of the vestibule
at the 3, 6, and 9 o’clock distribution. Electromyography testing of the
pelvic floor muscles (PFM) revealed normal PFM contractions and
resting tone. Her pain, however, was notably reproduced by intra-
vaginal peripheral nerve electrostimulation with a 100Hz probe.
Setting:
Women’s outpatient rehabilitation clinic.
Results:
She received 10 desensitization sessions via electro-stimula-
tion of the vagina. She reported immediate pain relief after each
session and reported a 90% improvement of pain overall at her final
session.
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Abstracts / PM R 9 (2017) S131-S290