correlations with tragus wall distance, modified Schober’s test, chest expansion (p¼0.048 r¼0.447; p¼0.008 r¼-0.573; p¼0.006 r¼-0.593). Those with increased T4-T12 angles had increased sway velocity on foam base, decreased step length in walk across test (p¼0.003 r¼0.630; p¼0.019 r¼-0.518). Conclusions: In all subject with AS, those with higher SS had higher VAS and BASDAI. The lumbar flexibility and chest expansion decreased in those with decreased T4-T12 angles. The subjects with increased thoracic kyphosis walked in shorter steps and had more sway on instable bases. We recommend avoiding progression of the thoracic kyphosis to protect lumbar flexibility and balance in AS. No. 262 The Effect of Paraspinal Muscles on the Clinical Outcomes in Subjects With Lumbar Spinal Canal Stenosis. Emel Ece Ozcan-Eksi; Ilker Yagci; Brian Feeley; Sibel Demir-Deviren. Disclosure: None. Objective: To determine the effect of atrophy and fatty infiltration of paraspinal muscles on the clinical outcomes in subjects with symptomatic LSS. Design: Prospective blinded controlled study. Setting: University-based spine center. Participants: Eleven female subjects with symptomatic LSS (mean age 57.0011.40 years). Main Outcome Measures: All subjects were assessed with modified Oswestry Disability Index (ODI) for disability, Roland Morris Questionnaire (RMQ) for functionality, McGill Pain Index (MPI) for pain, timed up and go (TUG) test, Berg balance scale for balance. We measured atrophy and fatty infiltration in lumbar multifidus, erector spinae, and psoas muscles on T1weighted axial MR images. The expected cross-sectional area and functional CSA (FCSA) of the muscles were measured by using free hand technique on OsirixÒ. Then the percentage of muscle atrophy was calculated. Fatty infiltration was graded by using Goutallier and quartile classifications. Level of Evidence: II. Results: Subjects with higher Goutallier and quartile scores for the erector spinae at L5-S1 had higher ODI scores. Subjects with greater erector spinae FCSA at L5-S1 had lower MPI scores (R¼-0.669). Subjects with greater multifidus FCSA at L4-L5 had lower RMQ scores (r¼-0.658). Subjects with more atrophy and fatty infiltration in the multifidus at L5-S1 took longer to complete the TUG test (r¼0.628; r¼0.652). The atrophy in total multifidus increased as the symptom duration prolonged (r¼-0.604). Conclusions: The fatty infiltration particularly in the erector spine at L5-S1 is more significant than the atrophy to predict the clinical outcomes in subjects with LSS. Disability also increased with more fatty infiltration in multifidus muscles. Further studies need to be done to determine the effect of the fatty infiltration and atrophy in paraspinal muscles on the treatment outcomes in patients with LSS. No. 263 Magnetic Resonance Therapy for Knee Osteoarthritis: A Double-Blind Placebo Controlled Trial. Nurgul Goksen; Mustafa Calis; Havva Talay Calis; Salih Ozgocmen (Dept. PMR Erciyes University Fac. Med. Kayseri, Turkey). Objective: To investigate the clinical and imaging efficacy of magnetic resonance therapy (MRT) in knee osteoarthritis (OA). Disclosure: None. Design: Prospective double-blind placebo controlled trial with 12-weeks follow up. Setting: A single center study conducted in a tertiary care academic medical center. Participants: One-hundred patients with mild to moderate knee osteoarthritis at a single knee joint. Patients between 30-75 years old without any history of knee surgery, malignancy, metallic implants, pacemakers, or active infection were included. Interventions: The treatment group (n¼50) received ten sessions of one hour MRT on ten consecutive days with two days of pause at weekend. Control group (n¼50) received placebo MRT. Main Outcome Measures: Patients were randomized by blinded switch cards (1:1). All patients underwent clinical examination; VAS-pain, WOMAC osteoarthritis index, quality of life (SF36), and Laquesne index (at baseline 2 weeks and 3 months). Imaging arm included ultrasonography and magnetic resonance (MR) of the knee. Level of Evidence: level 1. Results: Ninety-seven patients completed the study (2 in PLC and 1 in MRT group dropped out). No adverse effect was
PRESENTATIONS
reported during the study. The average change from baseline in outcome parameters over the treatment period (2 weeks) was similar for the MRT group (on VAS-pain-2.6; WOMAC-pain -2.09; WOMAC -morning stiffness -1.81; WOMAC-physical -1.96) compared to placebo (VAS-pain-1.6; WOMAC-pain -1.91; WOMAC-morning stiffness -1.27; WOMAC-physical -1.54 ) (p>0.05 for all). Changes from baseline over follow up (3 months) were also not different. SF-36 components at 3 months improved but changes were not significant. Imaging arm also failed to show significant differences between groups in terms of cartilage thickness on US and MR. Conclusion: MRT is a safe treatment for knee OA but not superior to placebo in terms of improvement in clinical or imaging parameters after ten days of one-hour treatment in mild to moderate knee OA. No. 264 Evaluation of the Efficacy and Temporal Pattern of Dry Needling in the Treatment of Myofascial Pain Syndrome. Marcus Yu Bin Pai; Juliana Takiguti Toma; Helena Hideko Seguchi Kaziyama; Daniel Ciampi De Andrade. Objectives: To evaluate in a prospective sham-controlled study the pattern of analgesic efficacy of trigger point dry needling in myofascial pain syndrome (MPS). Methods: We evaluated patients with unilateral shoulder pain and chronic MPS. Patients were randomly assigned to two treatment arms: active (A) (n¼20) and sham (S) (n¼21). Group A received trigger point dry needling. Group S received sham treatment. Patients were evaluated one week before needling (D-7), on the day of dry needling (D0), and seven days after the procedure (Dþ7). Patients filled out the Douleur Neuropathique 4, Beck Depression Inventory, Brief Pain Inventory (BPI), McGill pain questionnaire-SF (SFMPQ) and also filled out a 14-day pain diary with the first part of the BPI. Results: 41 patients were included. The reduction in pain intensity after treatment was significant for the active group (VAS before¼5419 vs. VAS after¼ 2920 p<0.05). Changes were not significant for the sham group (VAS before¼57.121.4 vs. VAS after¼ 48.529.5 p¼0.333). The total score of pain intensity in the SFMPQ was significantly improved in group A (before¼51.528.7 vs. After¼ 3031.6 p<0.05) but not in the sham group (before¼57.132.8 vs. 44.326.9; p¼0.104). The mean pain interference in life activities did not differ between groups. The worst pain and average 24 h pain score of BPI decreased in the active group only. There were no correlations between more intense pain during needling and immediate or long-term pain relief which was maximal on the 7th day after needling. Conclusions: Dry needling relieves pain when compared with sham procedure of same duration and pain intensity. The analgesic effect built up on the following days after stimulation and was higher on the 7th day after the procedure which argues for long-lasting local effects that go beyond the mechanical effect of the procedure. Needling may serve as a complementary therapeutic option in these patients. No. 265 Polymorphism of IL3 Is Associated With Complex Regional Pain Syndrome. Minho Park; Jinmann Chon; Seung Yeol Lee. Aim: Interleukin-3 (IL3) is a hematopoietic colony-stimulating factor that is capable of supporting the proliferation of broad range of hematopoietic cell types. IL3 also has neurotrophic activity. The aim of this study was to investigate whether promoter single nucleotide polymorphisms (SNP) (RS181781 -1107g/a) of the IL3 gene are associated with the development and ischemic stroke (IS). Method: We enrolled 121 IS patients and 291 control subjects. Genotype of SNP was determined by direct sequencing. SNP stats and SPSS 18.0 programs were used to evaluate odds ratios (ORs) 95% confidence intervals (CIs) and p-values. Multiple logistic regression models were performed to analyze genetic data. Results: The RS181781 SNP was associated with complex regional pain syndrome (CRPS) of IS (codominant 1 model OR¼0.21 95% CI¼0.07-0.69 p¼0.006; dominant model OR¼0.29 95% CI¼0.10-0.81 p¼0.013; overdominant model OR¼0.21 95% CI¼0.07-0.66 p¼0.0033). However the promoter SNP did not find difference between IS group and control group (p>0.05). Conclusion: The result suggests that the promoter SNP RS181781 of IL3 may be associated with the CRPS of IS in the Korean population.