S281 S290
Objective:
To ascertain if early MRI level of injury accurately de-
termines the clinically-assessed neurologic level of injury (NLI) in pa-
tients who have sustained acute blunt spinal cord trauma.
Design:
Prospective observational study.
Setting:
Level I trauma center.
Participants:
Patients enrolled into TRACK-SCI trial between 2015-
2017 who had both early MRI (within 24 hours of admission) and clinical
assessment of NLI (clinical NLI) within 48 hours of admission, 6 months
and 12 months after injury.
Interventions:
N/A.
Main Outcome Measures:
Three MRI measures of NLI were defined: 1)
cranial margin of spinal cord (SC) T2-hyperintensity, 2) caudal margin
of SC T2-hyperintensity, and 3) epicenter of injury as determined by
the axial level for which the BASIC score was obtained. Level desig-
nation was based on the vertebral level. Clinical NLIs were obtained
consistent with ASIA guidelines.
Results:
Spearman rank correlation analyses showed significant cor-
relation between all 3 early MRI measures of NLI and clinical NLI within
48 hours of admission, and 6-months post-injury (Spearman rhos
>
0.56, Ps
<
.05). Bland Altman agreement analyses showed that when
MRI NLI and edema boundaries were compared to clinical NLI, the
epicenter level used for BASIC scoring showed less overall bias and was
in closer agreement with clinical NLI, particularly at Day 1 and
6 months (mean vertebral level difference between measurements
<
1.0). MRI measures of NLI did not correlate with clinical NLI at 12
months (Spearman rhos
<
0.66, Ps
>
.05).
Conclusions:
Our prospective data validate prior retrospective data
showing correlation between MRI NLI and clinical NLI. Use of the BASIC
scoring system to determine the epicenter of injury shows closest
agreement with clinical NLI. Present data are the first to demonstrate
that early MRI measures of NLI do not correlate with long term (12
month) clinical NLI. Further investigation of conventional MRI measures
for predicting long term clinical NLI are warranted.
Level of Evidence:
Level II
CATEGORY: PAIN & SPINE MEDICINE
Poster 467:
Improved Functional Capacity but Stagnant
Real-Life Physical Activity After both Injection and Surgical
Decompression for Lumbar Spinal Stenosis
Patricia Z. Zheng, MD (Stanford Univ, Santa Clara, California, United
States), Galym Imanbayev, Bachelor of Arts, MD Candidate,
Amir Muaremi, PhD, Justin Norden, MPhil, Aman Sinha, MPhil,
Christy C. Tomkins-Lane, PhD, Matthew Smuck, MD
Disclosures:
Patricia Zheng: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
We compared free-living physical activity in patients who
underwent either injection or surgical decompression for lumbar spi-
nal stenosis (LSS).
Design:
This was a retrospective analysis of results from two separate
studies looking at outcomes after injection or surgical decompression
for LSS.
Setting:
3 tertiary medical institution in North America.
Participants:
At least 40 years of age, had received a diagnosis of LSS,
and were scheduled for epidural steroid injection (ESI) or surgical
treatment of LSS through a shared-decision process with the treating
physician.
Interventions:
ESI or surgical decompression for LSS.
Main Outcome Measures:
Reported (ODI, SSSQ, SF-36) function,
objective function (self-pacedwalk test (SPWT), and 7 days of free-living
physical activity as measured using Actigraph accelerometers were
measured at baseline and 1 week after ESI and 6 months after surgery.
Results:
Participants included 17 who underwent injections
(average 70.1 6.7 years old, 47% women) and 28 who underwent
surgeries (average 70.1 8.9 years old, 60.7% women). All subjec-
tive measures (ODI, SSSQ, and SF-36) improved significantly after
injections and surgeries, as did objective functional measures
including maximum ambulated distance (SPWT). However, objec-
tively measured real-life physical activity did not change after
either injections or surgeries. Patients were just as sedentary
after surgeries as they were after injections (82.7 5.4% vs
88.6 5.8%, P
¼
.09).
Conclusions:
Our studies were the first to track real-life physical
activity in people with LSS post-intervention. We found that after
both injections and surgeries, participants failed to demonstrate
increased physical activity as measured by continuous activity
monitoring. This lack of improvement in free-living physical activity
contrasts measured improvements in self-reported function and
objective ability to move. Given that we previously showed that a
focused multidisciplinary lifestyle modification program can increase
free-living physical activity levels and quality of life in patients with
LSS; our findings here suggest a role for focused post-intervention
rehabilitation to increase activity after interventions in the LSS
population.
Level of Evidence:
Level II
CATEGORY: NEUROLOGICAL REHABILITATION
Poster 469:
Incidence of Headaches in Combat Injured United
States Service Members and Veterans Deployed to Iraq and
Afghanistan with Traumatic Brain Injury (TBI)
Stephanie A. Jones, DO (Stanford University PM&R Program, Mountain
View, CA, United States), Molly A. Timmerman, DO, Olga Katsnelson,
RN
Disclosures:
Stephanie Jones: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
Post-traumatic headaches (PTHs) are significant compli-
cation of traumatic brain injury, a condition that our military popu-
lation is at higher risk of given their combat experience and an ever-
growing clinical concern as more of our active duty soldiers return
home from war. Our study sought to identify those at higher risk of
developing PTHs so that clinically we can offer treatment earlier and
facilitate assimilation into post-war life.
Design:
Retrospective chart review.
Setting:
Retrospective chart review.
Participants:
United States veterans or active duty service members
with combat deployments to either Iraq (Operation Iraqi Freedom
[OIF]) or Afghanistan (Operation Enduring Freedom [OEF]), who
screened positive for history of head injury and were seen in TBI
specialty clinic at Palo Alto Veterans Hospital from 2013-2017.
Interventions:
Not applicable.
Main Outcome Measures:
Self report of headaches in the moderate to
very severe range on neurobehavioral symptom index (NSI).
Results:
A total of 829 patients were identified who had physician
diagnosed, combat related head injury of any severity (mild, moder-
ate, and severe). Of those patients 613 (75%) reported headaches to be
a clinically significant problem in the moderate to very severe range on
NSI. Of patients with combat related head injury, 799 sustained mild
severity head injury, 25 sustained moderate severity head injury, and 5
sustained severe head injury. Incidence of headaches in patients who
sustained mild TBI was 596/799 (75%), moderate TBI 15/25 (60%), and
severe TBI was 2/5 (40%).
Conclusions:
The incidence of PTHs, though consequential for all
severities of TBI, was highest among patients with mild TBI. Clini-
cians should be vigilant about screening patients with all grades of
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Abstracts / PM R 9 (2017) S131-S290