S139 S290
Objective:
To identify characteristics of cervical radiculopathy which
are useful in predicting the therapeutic response to transforaminal
cervical epidural steroid injection (CESI).
Design:
Retrospective cohort study.
Setting:
Community-based multidisciplinary pain clinic and ambula-
tory surgery center.
Participants:
441 patients with cervical radicular pain and MRI-
confirmed cervical disc herniations or foraminal stenosis.
Interventions:
1 to 3 fluoroscopically-guided transforaminal CESIs.
Main Outcome Measures:
Reduction in self-reported numerical pain
score.
Results:
A series of 2-tailed t-tests was run to analyze the effect of
four pain characteristics on pain reduction from CESI, measured on
a 10-point scale. These variables were pain distribution, duration,
initial intensity, and etiology. In the first analysis, pain reduction in
patients with symptoms proximal to the elbow (Mean [M]
¼
2.3,
Standard Deviation [SD]
¼
2.2) versus symptoms extending distal to
the elbow (M
¼
2.4, SD
¼
2.2) was not significantly different (p
¼
.82).
In the second analysis, pain duration of
<
6 months (M
¼
2.8, SD
¼
2.6) compared to 6 months or longer (M
¼
2.3, SD
¼
2.1) was not found
to be a significant factor in pain reduction (p
¼
.08). In the third
analysis, pain reduction in patients with initial pain intensity of 7/
10 or higher (M
¼
2.9, SD
¼
2.5) compared to less than 7/10 (M
¼
2.0,
SD
¼
1.9) was significantly greater (p
<
.0001). Finally, CESI benefit for
stenosis etiology (M
¼
2.6, SD
¼
2.3) was significantly greater (p
¼
.006)
than for herniation etiology (M
¼
2.0, SD
¼
1.9). Subgroup analysis of
the 262 patients with pain due to cervical stenosis amplified the
beneficial effect of CESI for higher (M
¼
3.1, SD
¼
2.6) versus lower
(M
¼
2.0, SD
¼
1.9) initial pain level.
Conclusions:
In patients with cervical radiculopathy and associated
MRI findings of foraminal stenosis or disc herniation, CESI produces
greater therapeutic benefit in stenosis than in herniation. Patients
with higher initial pain levels achieve greater pain reduction, but this
pattern is only seen in the subgroup with radiculopathy attributed to
stenosis.
Level of Evidence:
Level III
Saturday, October 14, 2017
11:00 AM
e
12:00 PM
Exhibit Hall D, Exhibit Hall Level
RESEARCH SPOTLIGHT: PEDIATRIC REHABILITATION ePOSTER
SESSION
Poster 129:
Fibrocartilaginous Embolic Myelopathy: Epidemiology
and Presentation in a Retrospectively Identified
Pediatric Cohort
Brittany J. Moore, MD (Mayo Clinic of Rochester), Anna M. Batterson,
DO, Ronald K. Reeves, MD
Disclosures:
Brittany Moore: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
To describe epidemiology and clinical presentation of a
retrospectively identified cohort of pediatric spinal cord injury (SCI)
patients with suspected fibrocartilaginous embolic myelopathy
(FCEM).
Design:
Retrospective chart review using recently proposed criteria
for diagnosing FCEM ante mortem.
Setting:
Tertiary Care SCI Rehabilitation Unit.
Participants:
Between 2001 and 2016, 31 cases were identified
meeting study criteria for “high probability” of FCEM, 5 of which were
pediatric cases.
Interventions:
Not applicable.
Main Outcome Measures:
Demographic data, clinical presentation
characteristics, cerebrospinal fluid (CSF) evaluation, magnetic
resonance imaging (MRI) characteristics, rehabilitation unit discharge
diagnosis.
Results:
Age range was 9 to 17 years old, median age of 14 years old,
3/5 were male, and median BMI was 23. No patients had vascular risk
factors present. Most common presentation was acute pain (4/5).
Initial work-up most commonly showed spinal MRI with vascular dis-
tribution of abnormality (4/5) and normal CSF (3/4). Most common
discharge diagnosis was idiopathic transverse myelitis (3/5). Only 1
case had FCEM documented as a diagnostic possibility.
Conclusions:
Compared to the adult FCEM cohort, pediatric subjects
were more likely to have normal CSF protein levels; however, they
were less likely to have rapidly progressing symptomatology or exam
consistent with vascular distribution. This may signify that subjective
data are more difficult to ascertain in pediatric populations; thus,
reliance on objective data for FCEM diagnosis may be more important.
The pediatric cohort had lower incidence of degenerative changes on
MRI, which may reflect the different pathophysiologic mechanisms for
FCEM across the lifespan. While both cohorts had non FCEM-related
discharge diagnoses the majority of the time, the pediatric cohort was
more likely to be labeled as idiopathic transverse myelitis compared to
spinal cord infarct not otherwise specified in adults.
Level of Evidence:
Level IV
Poster 130:
Fibrocartilaginous Embolic Myelopathy: Functional
Outcomes in a Retrospectively Identified Pediatric
Cohort
Anna M. Batterson, DO (Mayo Clinic of Rochester, Rochester, MN,
United States), Brittany J. Moore, MD, Ronald K. Reeves, MD
Disclosures:
Anna Batterson: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
To describe functional outcomes of a retrospectively
identified cohort of pediatric spinal cord injury (SCI) patients with
suspected fibrocartilaginous embolic myelopathy (FCEM).
Design:
Retrospective chart review using recently proposed criteria
for diagnosing FCEM ante mortem.
Setting:
A tertiary care SCI rehabilitation unit.
Participants:
Between 2001 and 2016, 31 cases were identified
meeting study criteria for “high probability” of FCEM, 5 of which were
pediatric cases.
Interventions:
Not applicable.
Main Outcome Measures:
WeeFIM (functional independence mea-
sure) scores (including motor subscale), FIM motor change, FIM motor
efficiency, length of stay (LOS) in days on the inpatient rehabilitation
unit, discharge disposition, and bowel/bladder/mobility status at
discharge.
Results:
Median LOS was 30 days. The majority had tetraplegia (3/5),
with 2 cases having high neurological levels at C2 and C3. All patients
were incomplete and discharged directly to home. At discharge, the
majority of patients (3/5) required no assistive device for bladder
management. All patients were discharged with bowel medications.
Most patients discharged using a wheelchair (3/5). Functional inde-
pendence measure (FIM) scores were available from 4 cases. Median
motor WeeFIM subscale was 25 at admission and 58.5 at discharge with
a median efficiency of 0.67.
Conclusions:
Compared to adults with FCEM, pediatric patients were
more likely to have tetraplegia, and notably high tetraplegia, whereas
there were no cases of high tetraplegia in the adult cases. In addition,
the pediatric patients had lower median motor WeeFIM/FIM score at
discharge as well as overall motor WeeFIM/FIM efficiency, despite a
slightly longer overall LOS. Pediatric and adult cases were similar in
rates of discharge to home, completeness of injury, wheelchair
mobility, and bowel/bladder discharge management. These findings
may suggest that pediatric patients with FCEM may have higher
S139
Abstracts / PM R 9 (2017) S131-S290