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No. 257 Modic Changes: Antibiotic Treatment in Chronic Low Back Pain Patients With a Suspected Low Grade Discitis
PM&R
revealed 1/5 muscle strength in all extremities and sensory examination revealed hypoesthesia below C4 dermatome. C-spine MRI showed signal change with swelling of spinal cord at cervical cord and medulla oblongata with epidural fluid collection at upper cervical area. Leptomeningeal enhancement of medulla oblongata and cervical cord was also revealed at Cspine MRI. Surgery was performed but there was no neurological improvement. He has transferred to our rehabilitation department for comprehensive rehabilitation therapy. Lumbar ESI has become a common non-surgical treatment for LBP. But there is no clear recommendation of ESI including injection, amount of steroids, minimal interval, and other restrictions. Pain physicians should be aware of complications such as cervical meningomyelitis which should be considered in the differential diagnosis. No. 257 Modic Changes: Antibiotic Treatment in Chronic Low Back Pain Patients With a Suspected Low Grade Discitis. Claus Manniche; Lars Morsø; Lene Kiertzner. Disclosure: C.M. owns shares in the non-for-profit company Mast Educational; L.M. and L.K.: None. Objective: To evaluate the effect of a 3-month antibiotic treatment regime in patients referred to a secondary care outpatient spine centre with continuous low back pain following disc pathology and subsequent intervertebral Modic changes type 1 (MC1). Design: Cohort study. Setting: Amoxicillin/clavulanic acid for 3 months. Participants: 32 patients (15 female) with low back pain for more than 6 months referred to the spine centre. Inclusion: poor exercise tolerance, MRI demonstrating disc pathology in the lumbar spine including MC1, no effect of other non-surgical treatment forms. Main Outcome Measures: Patient’s global assessment at 6 months follow up. Change in spinal pain intensity on a 0-10 numerical rating scale. Numbers of nights with disturbed sleep (NNDS) caused by pain over a 14-night period. Results: The outcome analysis compares the treatment effect group and the non-treatment effect group. Patient global assessment: 59.4 % of the patients stated effect of treatment. Change of spinal pain intensity in “the effect group” at 6 months follow up 2.5[SD 2.0] and in “the non-effect group” -0.6[SD 1.9]. NNDS in “the effect group” at BL/6 months respectively; 7.6[SD 5.7]; 3.7[SD 5.2] in “the non-effect” at BL/ 6 month; 8.7 [SD 5.4]; 10.2[SD 5.0]. Substantive side effects were seen in 43% of patients. Discussion: The antibiotic treatment regime provides positive outcome results for 59% of the spinal pain patients. At 6 months a clinically relevant improvement regarding pain intensity was obtained and number of nights with disturbed sleep was reduced. No. 258 Pain Assessment in Knee Osteoarthritis: Objective Functional Outcomes Are Feasible?. Martins F; Imamura M; Oshiro MS; Lopes JA; Hsing WT; Batisttella LR (Institute of Physical Medicine and Rehabilitation of Clinical Hospital of Sao Paulo University School of Medicine, Sao Paulo, Brazil). Disclosure: None. Objectives: This study investigates correlation between subjective and auto related scales for pain (VAS), knee osteoarthritis impairment (WOMAC), health-related quality of life (SF-36), and objective variables (number of steps) in females up to 65 years old with knee OA. We aim to investigate the instrumental and clinical reliability of accelerometer and pedometer to dynamic condition evaluation of knee and the feasibility of objective functional outcomes for pain impact assessment. Design: Observational transversal study. Setting: Daily life. Participants: 26 patients with clinical and radiological primary knee osteoarthritis diagnosis and 25 healthy volunteers. Interventions: Not applicable. Main Outcome Measures: Pain visual analogic scale (VAS), knee osteoarthritis impairment (WOMAC), and health-related quality of life (SF-36) and total number of steps in 7 days using a pedometer and a multiaxial accelerometer. Level of Evidence: Level 1. Results: Accelerometer number of steps of both groups are statistically difference (p¼0.03). Pedometer number of steps counting shows that pedometer could not distinguish
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healthy or affected groups. The correlation between objective analysis (accelerometer number of steps) evidence significant negative correlation with pain, rigidity, and difficulties of WOMAC and VAS (t¼ -2.149 p¼0.037). With functional status, pain, vitality, general status and social function of SF-36 exist a positive correlation. Conclusion: Considering the negative correlation between VAS and accelerometer number of steps we suggest that objective functional evaluations like number of steps might be considered as functional outcomes besides only subjective and auto related scales in knee pain impact or interventional studies. Pedometer could not be useful in this population like accelerometer. No. 260 Spinal Segmental Sensitization Syndrome as a Common Cause of Chronic Musculoskeletal Pain: A Case Series Study. Tomas Nakazato Nakamine; Galo Camacho Honorio-A. Disclosure: None. Objective: To determine the prevalence of spinal segmental sensitization (SSS) syndrome and the radicular segments (RS) involved in a group of patients with chronic musculoskeletal pain (CMP) attending a physiatric consultation. Setting: Private practice physiatric office. Participants: 100 consecutive new patients (mean age 55 17 years 57 women) complaining of CMP. Interventions: Anamnesis and clinical examination of participants looking for symptoms and signs of SSS syndrome, a hyperactive state of a RS of the spinal cord whose main manifestations includes hyperalgesia of the dermatome, myofascial trigger points within the myotome, and pressure pain sensitivity of the sclerotome. Level of Evidence: 3. Main Outcome Measures: We used the following 4 clinical criteria for diagnosis: 1) chronic (>3 months) and regional (both axial and peripheral location) pain as described by the patient; 2) pain in one or more dermatomes with the “pinch and roll” maneuver and/or the scratch with the tip of a clip which identify the RS affected; 3) pain at palpation in one or more myofascial trigger points at paraspinal and non paraspinal muscles related to the RS identified previously; 4) pain at palpation of the interspinous ligament and in one or more non spinal sclerotomal structures of the same RS. Results: We found 34 patients with SSS syndrome most of them having more than one RS involved (20 patients). The most frequent RS were located at the lumbosacral region (9 at L5, 9 at S1) followed by the lumbar (4 at L2, 4 at L3, 6 at L4) and the mid-cervical (6 at C5, 8 at C6) regions. Conclusion: About a third of the patients evaluated for CMP had SSS syndrome according to the clinical criteria proposed. We need a consensus for the diagnosis of this entity which is a common cause of physiatric consultation. No. 261 The Effects of Spinal Curvatures on Balance in Ankylosing Spondylitis. Emel Ece Ozcan-Eksi; Esra Giray; Osman Hakan Gunduz; Ilker Yagci. Disclosure: None. Objective: 1) To compare female and male subjects with ankylosing spondylitis (AS) in posture, spinal curves, and balance and 2) to identify the effects of spinal curves on balance. Design: Prospective controlled study. Setting: University based outpatient clinic, University based spine center. Participants: Twenty subjects with AS (8 female 12 male). Main Outcome Measures: In all subjects spinal curves [T4-T12 angle, lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI)] were assessed on lateral spine x-rays by using SurgimapÒ program. Balance was assessed by using Neurocom Balance Master SystemÒ (Orlando, USA) assisted tests (standing on firm & foam bases, walk across, tandem walk, step & quick turn); posture assessment (tragus wall distance, modified Schober’s test, chest expansion); pain (VAS); disease activity (BASDAI). Results: The groups were similar in age (mean: 43.158.28 years), BMI (27.015.56 kg/m2), VAS (5.702.34), BASDAI (4.752.67). The LL was higher in females (57.6213.58o) than in males (41.8317.36o) (p¼0.036). The sway in Step & Quick turn test was higher in females (p¼0.006). In all those with higher VAS had higher LL and SS (p¼0.036 r¼0.472; p¼0.016 r¼0.533); those with higher BASDAI had higher SS (p¼0.021 r¼0.526). The T4-T12 angle had significant
revealed 1/5 muscle strength in all extremities and sensory examination revealed hypoesthesia below C4 dermatome. C-spine MRI showed signal change with swelling of spinal cord at cervical cord and medulla oblongata with epidural fluid collection at upper cervical area. Leptomeningeal enhancement of medulla oblongata and cervical cord was also revealed at Cspine MRI. Surgery was performed but there was no neurological improvement. He has transferred to our rehabilitation department for comprehensive rehabilitation therapy. Lumbar ESI has become a common non-surgical treatment for LBP. But there is no clear recommendation of ESI including injection, amount of steroids, minimal interval, and other restrictions. Pain physicians should be aware of complications such as cervical meningomyelitis which should be considered in the differential diagnosis. No. 257 Modic Changes: Antibiotic Treatment in Chronic Low Back Pain Patients With a Suspected Low Grade Discitis. Claus Manniche; Lars Morsø; Lene Kiertzner. Disclosure: C.M. owns shares in the non-for-profit company Mast Educational; L.M. and L.K.: None. Objective: To evaluate the effect of a 3-month antibiotic treatment regime in patients referred to a secondary care outpatient spine centre with continuous low back pain following disc pathology and subsequent intervertebral Modic changes type 1 (MC1). Design: Cohort study. Setting: Amoxicillin/clavulanic acid for 3 months. Participants: 32 patients (15 female) with low back pain for more than 6 months referred to the spine centre. Inclusion: poor exercise tolerance, MRI demonstrating disc pathology in the lumbar spine including MC1, no effect of other non-surgical treatment forms. Main Outcome Measures: Patient’s global assessment at 6 months follow up. Change in spinal pain intensity on a 0-10 numerical rating scale. Numbers of nights with disturbed sleep (NNDS) caused by pain over a 14-night period. Results: The outcome analysis compares the treatment effect group and the non-treatment effect group. Patient global assessment: 59.4 % of the patients stated effect of treatment. Change of spinal pain intensity in “the effect group” at 6 months follow up 2.5[SD 2.0] and in “the non-effect group” -0.6[SD 1.9]. NNDS in “the effect group” at BL/6 months respectively; 7.6[SD 5.7]; 3.7[SD 5.2] in “the non-effect” at BL/ 6 month; 8.7 [SD 5.4]; 10.2[SD 5.0]. Substantive side effects were seen in 43% of patients. Discussion: The antibiotic treatment regime provides positive outcome results for 59% of the spinal pain patients. At 6 months a clinically relevant improvement regarding pain intensity was obtained and number of nights with disturbed sleep was reduced. No. 258 Pain Assessment in Knee Osteoarthritis: Objective Functional Outcomes Are Feasible?. Martins F; Imamura M; Oshiro MS; Lopes JA; Hsing WT; Batisttella LR (Institute of Physical Medicine and Rehabilitation of Clinical Hospital of Sao Paulo University School of Medicine, Sao Paulo, Brazil). Disclosure: None. Objectives: This study investigates correlation between subjective and auto related scales for pain (VAS), knee osteoarthritis impairment (WOMAC), health-related quality of life (SF-36), and objective variables (number of steps) in females up to 65 years old with knee OA. We aim to investigate the instrumental and clinical reliability of accelerometer and pedometer to dynamic condition evaluation of knee and the feasibility of objective functional outcomes for pain impact assessment. Design: Observational transversal study. Setting: Daily life. Participants: 26 patients with clinical and radiological primary knee osteoarthritis diagnosis and 25 healthy volunteers. Interventions: Not applicable. Main Outcome Measures: Pain visual analogic scale (VAS), knee osteoarthritis impairment (WOMAC), and health-related quality of life (SF-36) and total number of steps in 7 days using a pedometer and a multiaxial accelerometer. Level of Evidence: Level 1. Results: Accelerometer number of steps of both groups are statistically difference (p¼0.03). Pedometer number of steps counting shows that pedometer could not distinguish
Vol. 6, Iss. 8S2, 2014
S143
healthy or affected groups. The correlation between objective analysis (accelerometer number of steps) evidence significant negative correlation with pain, rigidity, and difficulties of WOMAC and VAS (t¼ -2.149 p¼0.037). With functional status, pain, vitality, general status and social function of SF-36 exist a positive correlation. Conclusion: Considering the negative correlation between VAS and accelerometer number of steps we suggest that objective functional evaluations like number of steps might be considered as functional outcomes besides only subjective and auto related scales in knee pain impact or interventional studies. Pedometer could not be useful in this population like accelerometer. No. 260 Spinal Segmental Sensitization Syndrome as a Common Cause of Chronic Musculoskeletal Pain: A Case Series Study. Tomas Nakazato Nakamine; Galo Camacho Honorio-A. Disclosure: None. Objective: To determine the prevalence of spinal segmental sensitization (SSS) syndrome and the radicular segments (RS) involved in a group of patients with chronic musculoskeletal pain (CMP) attending a physiatric consultation. Setting: Private practice physiatric office. Participants: 100 consecutive new patients (mean age 55 17 years 57 women) complaining of CMP. Interventions: Anamnesis and clinical examination of participants looking for symptoms and signs of SSS syndrome, a hyperactive state of a RS of the spinal cord whose main manifestations includes hyperalgesia of the dermatome, myofascial trigger points within the myotome, and pressure pain sensitivity of the sclerotome. Level of Evidence: 3. Main Outcome Measures: We used the following 4 clinical criteria for diagnosis: 1) chronic (>3 months) and regional (both axial and peripheral location) pain as described by the patient; 2) pain in one or more dermatomes with the “pinch and roll” maneuver and/or the scratch with the tip of a clip which identify the RS affected; 3) pain at palpation in one or more myofascial trigger points at paraspinal and non paraspinal muscles related to the RS identified previously; 4) pain at palpation of the interspinous ligament and in one or more non spinal sclerotomal structures of the same RS. Results: We found 34 patients with SSS syndrome most of them having more than one RS involved (20 patients). The most frequent RS were located at the lumbosacral region (9 at L5, 9 at S1) followed by the lumbar (4 at L2, 4 at L3, 6 at L4) and the mid-cervical (6 at C5, 8 at C6) regions. Conclusion: About a third of the patients evaluated for CMP had SSS syndrome according to the clinical criteria proposed. We need a consensus for the diagnosis of this entity which is a common cause of physiatric consultation. No. 261 The Effects of Spinal Curvatures on Balance in Ankylosing Spondylitis. Emel Ece Ozcan-Eksi; Esra Giray; Osman Hakan Gunduz; Ilker Yagci. Disclosure: None. Objective: 1) To compare female and male subjects with ankylosing spondylitis (AS) in posture, spinal curves, and balance and 2) to identify the effects of spinal curves on balance. Design: Prospective controlled study. Setting: University based outpatient clinic, University based spine center. Participants: Twenty subjects with AS (8 female 12 male). Main Outcome Measures: In all subjects spinal curves [T4-T12 angle, lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI)] were assessed on lateral spine x-rays by using SurgimapÒ program. Balance was assessed by using Neurocom Balance Master SystemÒ (Orlando, USA) assisted tests (standing on firm & foam bases, walk across, tandem walk, step & quick turn); posture assessment (tragus wall distance, modified Schober’s test, chest expansion); pain (VAS); disease activity (BASDAI). Results: The groups were similar in age (mean: 43.158.28 years), BMI (27.015.56 kg/m2), VAS (5.702.34), BASDAI (4.752.67). The LL was higher in females (57.6213.58o) than in males (41.8317.36o) (p¼0.036). The sway in Step & Quick turn test was higher in females (p¼0.006). In all those with higher VAS had higher LL and SS (p¼0.036 r¼0.472; p¼0.016 r¼0.533); those with higher BASDAI had higher SS (p¼0.021 r¼0.526). The T4-T12 angle had significant