S174 S290
tasks. Participants with SCI had similar activity counts within tasks
compared to those without SCI except for walking/wheeling. Agree-
ment was high between monitors across tasks (ICCs
¼
.78 - .92).
Conclusions:
Both monitors demonstrated good construct validity for
measuring physical activity across activities and high agreement.
Either monitor may be appropriate to examine physical activity pat-
terns in individuals with SCI.
Level of Evidence:
Level II
Poster 122:
Quality Surveillance of Cooled Radiofrequency
Neurotomy Procedure
Haewon Lee, MD (Hosp of Univ of PA, Philadelphia, PA, United States),
William J. Bonner, MD
Disclosures:
Haewon Lee: I Have No Relevant Financial Relationships
To Disclose
Objective:
To assess areas for quality improvement for cooled radi-
ofrequency neurotomy/ablation (CRFA).
Design:
Quality improvement.
Setting:
Academic spine center.
Participants:
Patients who underwent CRFA at the spine center from
8/2013 through 3/2016.
Interventions:
Not applicable.
Main Outcome Measures:
Assessing complications attributed to CRFA
procedure. Developing a practice intervention to improve safety.
Results:
Cooled radiofrequency neurotomy (CRFA) is a procedure
commonly used to treat back pain suspected to emanate from the
zygapophyseal joint. We conducted a surveillance review of CRFAs
performed at an academic outpatient spine care center to assess for
any possible associated quality and safety issues at this facility, with
the goal to develop a strategy that would target any identified prob-
lem areas. We found that between 8/2013 and 3/2016, 87 patients
received a total of 316 radiofrequency lesions during 131 separate
denervation procedures. 13 minor complications were identified in 12
patients, yielding a 0.04% overall incidence of minor complications per
radiofrequency site. Complications included: 8 cases of increased pain
following the procedure; 2 cases of mild hypersensitivity reaction
(rash) that resolved over the course of several days; 3 cases of
neurologic complaints, which included transient sensory block of a
lower extremity, transient myotomal weakness, paresthesia, and
vasovagal symptoms. 1 patient reported both pain and hypersensitivity
reaction following a procedure. No cases of infection, death, or serious
long-term adverse effects were reported. All complications were mild
to moderate, and self-limiting. Furthermore, there is no evidence that
these complications were linked to physician or staff practice, to the
facility, nor to pre- or post-procedural patient instructions.
Conclusions:
Our quality improvement surveillance suggests that
CRFA performed at this facility is a generally safe and well-tolerated
procedure.
Level of Evidence:
Level IV
Poster 123:
Cadaveric Study of the Articular Branches of the
Shoulder Joint
Brittany L. Bickelhaupt, MD (Univ of TX HSC - San Antonio, San
Antonio, TX, United States), Jacob E. Fehl, MD, Maxim Eckmann, MD,
Ameet S. Nagpal, MD, MS, MEd, FAAPMR
Disclosures:
Brittany Bickelhaupt: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
This cadaveric study investigated the anatomic relation-
ships of the terminal articular branches of the suprascapular, axillary,
and lateral pectoral nerves (SN, AN, LPN), providing implications for
fluoroscopic and ultrasound guided peripheral nerve blockade or
ablation.
Design:
19 cadavers and 37 shoulders were evaluated and dissected in
an anatomy lab. Each nerve was dissected into its terminal sensory
branches.
Setting:
The study was performed in a medical school anatomy lab.
Participants:
19 cadavers and 37 shoulders were evaluated.
Interventions:
Not applicable.
Main Outcome Measures:
Primary outcomes were percent consis-
tency in neuroanatomy of each terminal articular branch.
Results:
19/25 (76%) had intact lateral pectoral nerves with 17/19
(89%) displaying articular branches innervating the anterior shoulder
joint. 19/19 (100%) had LPN articular branches traveling with acromial
branches of the thoracoacromial blood vessels over the superior
aspect of the coracoid process. 20/20 (100%) had intact suprascapular
nerves innervating the posterior head of the humerus and shoulder
capsule. The axillary nerve terminal branches innervated the
posterolateral head of the humerus and shoulder capsule with 20/20
(100%) precision and intact nerves. Suprascapular sensory branches
were identified posteriorly travelling directly laterally to the spino-
glenoid notch and also descending from the notch and returning back
to the capsule over the glenohumeral junction. The axillary nerve gave
branches ascending circumferentially from the quadrangular space to
the posterolateral humerus and then dove deep to the deltoid and
superiorly toward the inferior portion of the posterior capsule.
Conclusions:
Safe zones for blocking terminal articular branches of
the SN, AN, and LPN appear accessible with potential avoidance of
motor blockade. Articular branches of the LPN exist and innervate a
portion of the anterior shoulder joint. The LPN articular branch has a
consistent relationship with thoracoacromial vessels. Articular
branches of the SN and AN are accessible in the capsule overlying the
glenohumeral joint posteriorly.
Level of Evidence:
Level II
Poster 124:
Office-Based Stem Cell Therapies for Painful
Degenerative Facetogenic and Sacroiliac Joint
Disease: A Case Series
Christine L. Hunt (Mayo Clinic College of Medicine, Rochester, MN,
USA), Jason S. Eldrige, MD, MD, William D. Mauck, MD, Andre J. van
Wijnen, PhD, Wenchun Qu, MD, PhD
Disclosures::
Christine Hunt: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
To report on the use of a novel therapeutic regimen for the
treatment of painful degenerative facetogenic and sacroiliac joint
disease (fluoroscopically guided injection of bone marrow aspirate
concentrate with platelet-rich plasma) and to generate hypotheses
that may be appropriate for testing in clinical trials assessing the
safety and efficacy of this treatment.
Design:
Observational, case series.
Setting:
Academic medical center.
Participants:
9 patients with painful degenerative disease of the
facet and/or SI joints who had failed conservative treatment with
analgesics and physical therapy.
Interventions:
Fluoroscopically guided facet and/or SI joint injection
of autologous bone marrow aspirate concentrate (minimally manipu-
lated mesenchymal stem cells) with platelet-rich plasma.
Main Outcome Measures:
The primary outcome of this case series is
safety as measured by reporting of adverse events. We also provide a
qualitative description of patient-reported outcome measures that are
being followed in several subjects, although we do not endeavor to
draw any conclusions in terms of efficacy in this case series.
Results:
No adverse events have been reported, providing evidence
that this treatment is safe and demonstrating its feasibility in the
office-based setting. All nine patients have reported improvement in
pain, function, and/or narcotic use and this will be described,
although this study design precludes analysis of efficacy.
S174
Abstracts / PM R 9 (2017) S131-S290