- Email: [email protected]
Pelvic Incidence in Patients with Hip Osteoarthritis
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Proceedings of the NASS 27th Annual Meeting / The Spine Journal 12 (2012) 65S–80S
diamond tipped drill bit, partially drilling the medial cortex and entering the vertebral body with the drill itself. All patients underwent CT scans to evaluate the screw placement. RESULTS: In Group-I, 33 pedicle screws (C3-C7) were placed and 23 screws were placed in Group-II. In Group-I, more of lateral perforations were observed with 18.2% Grade-II and 12.1% Grade III lateral perforations. Medial perforations were lower with 6% Grade-II and 0% GradeIII perforations respectively. In Group -II the lateral perforations were low with 8.7% Grade-II and 0% Grade-III lateral perforations. The Grade-II and Grade-III medial perforations in Group-II were 48.48% and 4.34%, respectively. No clinical neuro-vascular complications were seen in either of the groups postoperatively. CONCLUSIONS: With use of Abumi et al technique, most of the CPS perforations described are lateral. Use of a blunt pedicle probe always directs the surgeon towards the lateral cortex as the medial cortex is thicker and stronger. With the new technique described, lateral perforations were very low and there were no grade-III lateral perforations seen. Though there were significantly more medial perforations in the new technique, most of them were Grade-II perforations, understandably due to partial drilling of medial cortex. Partial breach of medial pedicle cortex in the cervical spine has minimal clinical complications as dura or cervical roots are not in contact with medial cortex. Breach or thinning of the medial cortex can be easily perceived through the drill bit as commonly done during laminoplasty/ laminectomy, with the diamond tip. In addition, using the high speed drill prevents excessive transmission of forces to the unstable cervical spine while pilot hole preparation, which occurs with the use pedicle probe. Cervical pedicle screw placement using high speed drill is safe and decreases the incidence of lateral perforations as compared to the use of a blunt pedicle probe. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.195
Friday, October 26, 2012 11:00 AM – 12:00 PM Current Concepts in Lumbopelvic Pain Seminar 134. Hip and Lumbar Spine Physical Examination and Radiographic Findings in Consecutive Patients Presenting with Low Back Pain: A Prospective Description of the Hip-Spine Syndrome Heidi Prather, DO1, Abby Stephens2, Vaibhav Maheshwari, DO1, Linda R. Van Dillen, PT, PhD1; 1Washington University School of Medicine, St. Louis, MO, US; 2St. Louis, MO, US BACKGROUND CONTEXT: The etiology of low back pain (LBP) is not well understood. Retrospective studies described co-existing hip and spine disorders, the hip-spine syndrome, in patients with hip osteoarthritis (OA). Another group of studies determined aberrant hip motion to be contributor to LBP and, when corrected, can reduce LBP. Further, there are descriptions of patients with symptomatic hip deformity associated with aberrant hip motion and LBP. Collectively, this literature suggests hip assessment is important to understand etiologies for LBP in a subgroup of patients. PURPOSE: Determine hip physical examination and radiographic findings in patients presenting with LBP to assess coexisting hip and spine disorders. STUDY DESIGN/SETTING: Prospective descriptive study at a tertiary university. PATIENT SAMPLE: Consecutive patients with LBP. OUTCOME MEASURES: Numeric pain scale (NPS), UCLA hip questionnaire, Roland-Morris (RM) questionnaire and Modified Oswestry Index (mODI), Modified Harris Hip Score (mHHS).
METHODS: Consecutive adult patients presenting to a physiatrist completed demographic information and outcome measures. Physical examination tests were recorded including: lumbar and hip provocation, hip range of motion (ROM), active straight leg raise (ASLR), and early lumbopelvic motion with hip rotation. Hip radiograph measurements to assess deformity and OA were completed by an independent examiner including: lateral center of edge angle (LCEA), alpha angle, acetabular inclination (AI), cross-over sign, and Tonnis grade. Pain and function were compared in patients with hip findings on physical examination and radiographs to those without hip findings. RESULTS: A total of 101 consecutive patients (68 F, 33 M) with mean age 47.6 years (range 18.4-79.8) completed the study. Median length of time of pain was 6 months (range 10 days-33 years). Lumbar spine provocative tests were negative in five patients. Significantly less hip flexion (HF) (p50.008) in 90 patients and hip internal rotation (HIR) (p50.002) in 88 patients were found in the LBP patients as compared to age and gender matched controls. Reduced HF was associated with significantly worse mODI (p50.04) and mHHS (p50.02). Reduced HIR was associated with significantly worse RM (p50.003). One or two positive provocative hip tests were found in 65 patients and 4 positive tests were found in 21 patients. ASLR was positive in 46 patients and early lumbopelvic motion with hip rotation was found in 77 patients. All outcome measures were found to be significantly worse (p values ranging p50.05 to p50.0001) in patients with positive provocative hip tests. Percentages of patients with abnormal radiograph measurements consistent with hip deformity included: 31.7% LCEA, 26.6% AI, 40% crossover sign, 76% alpha angle. OA was found in 18% of patients. Those with hip pincer deformity had significantly worse mODI (p50.01), RM (p50.002), and mHHS (p50.003). All outcome measures were significantly worse in patients with hip OA (p values ranging p50.02 to p50.0001). CONCLUSIONS: Many patients presenting with LBP had positive hip provocative tests, reduced HF and HIR and positive hip radiographic findings. These hip physical examination and radiographic findings in patients with LBP were associated with worse baseline pain and function scores as compared to patients with LBP without hip findings. Coexisting hip and spine disorders are more common than previously recognized and occur in patients without hip OA. It is important to examine the hip when evaluating patients with LBP to determine appropriate treatment. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.197
135. Pelvic Incidence in Patients with Hip Osteoarthritis Kris Radcliff, MD1, Ibrahim J. Raphael, MD1, Mohammad R. Rasouli, MD1, Christopher K. Kepler, MD, MBA2, Todd J. Albert, MD1, Javad Parvizi, MD, FRCS1; 1Rothman Institute, Philadelphia, PA, US; 2 New York, NY, US BACKGROUND CONTEXT: Hip osteoarthritis (HOA) is a major cause of pain and disability that results in considerable social and medical costs. Mechanics such as posture, alignment and orientation of the hips and the spinal column and the relationship between these factors have been implicated in the development of both hip and spine pathologies. PURPOSE: Assess the association of pelvic incidence with hip osteoarthritis. PATIENT SAMPLE: One hundred patients with moderate to severe hip osteoarthritis and 87 patients without hip osteoarthritis. OUTCOME MEASURES: Pelvic Incidence angle in patients with and without hip osteoarthritis. METHODS: Supine pelvis CT scans of 1,012 consecutive patients were collected. These patients were evaluated for various reasons; none were known to have HOA. Our first group consisted of 100 patients with
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
Proceedings of the NASS 27th Annual Meeting / The Spine Journal 12 (2012) 65S–80S moderate to severe HOA as per radiology reports. The second group included 87 patients with no evidence of HOA. Power analysis revealed the need for 77 patients per group to find a mean difference in PI of 5 or less between both groups. On the sagittal cut passing through the midline of the vertebral column, the PI was determined by measuring the angle formed by a perpendicular to the middle of the superior sacral endplate and the midpoint of the line joining the centers of the femoral heads. Two trained physicians independently measured PI angles, to account for inter-observer reliability. RESULTS: By averaging the PI of both observers, the group of patients with moderate to severe HOA had a mean PI of 56.47 6 13.86. The mean PI for the group of patients without signs of HOA was 55.67 6 8.41. An independent samples t-test revealed no significant difference between the PI values of moderate to severe and absent HOA groups (p50.630). Spearman’s correlation coefficient of 0.754 demonstrated a high inter-observer reliability. CONCLUSIONS: There was no difference in PI angle of HOA patients and ‘‘healthy’’ patients. Our measurements of patients without OA were almost identical to the reported normal PI values in the literature.HOA is not associated with PI angle, refuting the hypothesis made in previous studies, stating that elevated PI contributes to the future development of HOA. CT scan seems to be a reliable and accurate way of assessing pelvic incidence. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.198
136. The Symphysis in Patients with SI Joint Pain: A Pilot Study Stephan W. Becker, MD; IMSART Medimpuls, Vienna, Austria BACKGROUND CONTEXT: Sacroiliac (SI) joint pain and minimal-invasive therapies have recently become a matter of interest. However the diagnosis of SI pain is not based on a single examination, but represents a mosaic of clinical examination, CT and SI joint injections.As the pelvis is a three-dimensional structure, any changes of the sacro-iliacal joint should influence the other joints of the pelvis. PURPOSE: Investigation of the symphysis in SI joint patients in order to define possible additional methods to diagnose SI – joint pain. STUDY DESIGN/SETTING: Retrospective case control study. PATIENT SAMPLE: Twenty consecutive patients with clear SI joint pathology (confirmed by SI joint injections) versus 20 patients with back pain without SI joint pathology. OUTCOME MEASURES: Description and analysis of X-ray changes. METHODS: Anaylsis of rediological reports and independent assessment by 2 orthopedic surgeons. RESULTS: Overall, three different pathological types of the symphysis could be distinguished: osteoarthritic degeneration (type 1), subluxation (type 2) and fusion (type three). The verum group contained 17 women (mean age 61y) and 3 men (mean age 48y). Nineteen patients showed abnormalities of the symphysis with all women having either type 1 (7 patients) or type 2 (10 patients) changes. The men showed one normal joint, one type 1 and one type 3 change. Only 3 radiology reports mentioned the found changes in the verum group. Several patients in the verum group were treated with minimal-invasive fusion.The control group contained 16 female (mean age 69y) and 4 male patients (mean age 61y). Changes were found in 7 patients (5 type 1, 2 type 2, no type 3; 6 female and one male patient). No radiological report mentioned those changes. CONCLUSIONS: Unlike the SI – joint, the symphysis can be easily diagnosed on plain X-rays. Any changes of the symphysis are underreported in radiological reports. We found significantly more changes of the symphysis in patients with confirmed SI joint pain than in patients with back pain. Therefore the symphysis may represent another important piece in
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the mosaic of SI joint diagnosis. Due to the low number of patients we could not find a specific pattern of symphysis change in patients with SI joint pathology. FDA DEVICE/DRUG STATUS: IFuse (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2012.08.199
137. Can Sacroiliac Joint Aspiration Assist in Diagnosis? A Pilot Study Matthew W. Smuck, MD1, Ma.Agnes, Ith, MD2, S. Raymond Golish, MD, PhD3, Eugene J. Carragee, MD4, Lyly Cao Minh, MD5, Lewis S. Hanna, PhD6, Gaetano J. Scuderi, MD7; 1Menlo Park, CA, US; 2Stanford, Redwood City, CA, US; 3InMotion Clinic, Longview, WA, US; 4Stanford University School of Medicine, Redwood City, CA, US; 5Palo Alto, CA, US; 6Cytonics Corporation, Jupiter, FL, US; 7Jupiter, FL, US PURPOSE: Sacroiliac joint (SIJ) dysfunction is felt to be an increasingly recognized cause of low back pain (LBP). The aim of this investigation was to determine the viability of obtaining sample material for inflammatory cytokines in the SIJ of symptomatic patients which may assist in improving our efficacy. METHODS: Inclusion criteria included age O18, and no previous surgery on the SIJ. Patients were identified during the period of December 2010to September 2011. Participants were identified after physical exam (compression, FABER and Gaenslen tests) identified the SIJ as a likely cause of symptoms. At the time of injection, done fluoroscopically, upon introduction of the needle, 2 cc of physiologic saline was injected and then recovered and placed on ice for transport to a -80 C freezer, where kept until analysis. The concentration of the fibronectin aggrecan complex (FAC) and 15 cytokines/chemokines were measured using a multiplex immunoassay. The mediators included: FAC, IL-1b, IL1-RA, IL-6, Eotaxin, IFN-g(interferon gamma), MCP-1 (monocyte chemoattractant protein-1), MIP-1b PDGF-BB, RANTES, TNF-alpha and VEGF. Also we measured MMP-1, MMP-3, MMP-9. RESULTS: Thirteen patients underwent lavage and injection. Age range was 26-90 (mean 58.5). There were 10 females and 3 males. Seven right and 6 left. At 2 week fu 7/13 had ODI improvement of more than 20 points. IL-1ra appears to be elevated in patients that improved but we are underpowered. Volumes obtained were uniformly low and variable. Sampling the SIJ appears to be a valid technique that needs refining. CONCLUSIONS: Obtaining fluid from the SI joint is possible but variable. Better sampling methods need to be developed. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.200
138. Nonoperative Management of Coccydynia: A Comparative Study Comparing Three Methods Soumya Chakraborty, MBBS, MS; PGIMER, Chandigarh, India BACKGROUND CONTEXT: Coccydynia is a cause of morbidity worldwide. Various conservative options have been tried with success rate reaching up to 90%. PURPOSE: This study compares the role of manipulation alone, corticosteroid injection alone and combined manipulation and corticosteroid injection in the management of Coccydynia. STUDY DESIGN/SETTING: Prospective, randomized trial comparing three methods of treatment with follow up at 1 month and 1 year. PATIENT SAMPLE: Ninety-four patients (Jan 2007 to Dec 2009) with Coccydynia were selected on the basis of detailed history taking, clinical examination, and radiography.
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
Proceedings of the NASS 27th Annual Meeting / The Spine Journal 12 (2012) 65S–80S
diamond tipped drill bit, partially drilling the medial cortex and entering the vertebral body with the drill itself. All patients underwent CT scans to evaluate the screw placement. RESULTS: In Group-I, 33 pedicle screws (C3-C7) were placed and 23 screws were placed in Group-II. In Group-I, more of lateral perforations were observed with 18.2% Grade-II and 12.1% Grade III lateral perforations. Medial perforations were lower with 6% Grade-II and 0% GradeIII perforations respectively. In Group -II the lateral perforations were low with 8.7% Grade-II and 0% Grade-III lateral perforations. The Grade-II and Grade-III medial perforations in Group-II were 48.48% and 4.34%, respectively. No clinical neuro-vascular complications were seen in either of the groups postoperatively. CONCLUSIONS: With use of Abumi et al technique, most of the CPS perforations described are lateral. Use of a blunt pedicle probe always directs the surgeon towards the lateral cortex as the medial cortex is thicker and stronger. With the new technique described, lateral perforations were very low and there were no grade-III lateral perforations seen. Though there were significantly more medial perforations in the new technique, most of them were Grade-II perforations, understandably due to partial drilling of medial cortex. Partial breach of medial pedicle cortex in the cervical spine has minimal clinical complications as dura or cervical roots are not in contact with medial cortex. Breach or thinning of the medial cortex can be easily perceived through the drill bit as commonly done during laminoplasty/ laminectomy, with the diamond tip. In addition, using the high speed drill prevents excessive transmission of forces to the unstable cervical spine while pilot hole preparation, which occurs with the use pedicle probe. Cervical pedicle screw placement using high speed drill is safe and decreases the incidence of lateral perforations as compared to the use of a blunt pedicle probe. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.195
Friday, October 26, 2012 11:00 AM – 12:00 PM Current Concepts in Lumbopelvic Pain Seminar 134. Hip and Lumbar Spine Physical Examination and Radiographic Findings in Consecutive Patients Presenting with Low Back Pain: A Prospective Description of the Hip-Spine Syndrome Heidi Prather, DO1, Abby Stephens2, Vaibhav Maheshwari, DO1, Linda R. Van Dillen, PT, PhD1; 1Washington University School of Medicine, St. Louis, MO, US; 2St. Louis, MO, US BACKGROUND CONTEXT: The etiology of low back pain (LBP) is not well understood. Retrospective studies described co-existing hip and spine disorders, the hip-spine syndrome, in patients with hip osteoarthritis (OA). Another group of studies determined aberrant hip motion to be contributor to LBP and, when corrected, can reduce LBP. Further, there are descriptions of patients with symptomatic hip deformity associated with aberrant hip motion and LBP. Collectively, this literature suggests hip assessment is important to understand etiologies for LBP in a subgroup of patients. PURPOSE: Determine hip physical examination and radiographic findings in patients presenting with LBP to assess coexisting hip and spine disorders. STUDY DESIGN/SETTING: Prospective descriptive study at a tertiary university. PATIENT SAMPLE: Consecutive patients with LBP. OUTCOME MEASURES: Numeric pain scale (NPS), UCLA hip questionnaire, Roland-Morris (RM) questionnaire and Modified Oswestry Index (mODI), Modified Harris Hip Score (mHHS).
METHODS: Consecutive adult patients presenting to a physiatrist completed demographic information and outcome measures. Physical examination tests were recorded including: lumbar and hip provocation, hip range of motion (ROM), active straight leg raise (ASLR), and early lumbopelvic motion with hip rotation. Hip radiograph measurements to assess deformity and OA were completed by an independent examiner including: lateral center of edge angle (LCEA), alpha angle, acetabular inclination (AI), cross-over sign, and Tonnis grade. Pain and function were compared in patients with hip findings on physical examination and radiographs to those without hip findings. RESULTS: A total of 101 consecutive patients (68 F, 33 M) with mean age 47.6 years (range 18.4-79.8) completed the study. Median length of time of pain was 6 months (range 10 days-33 years). Lumbar spine provocative tests were negative in five patients. Significantly less hip flexion (HF) (p50.008) in 90 patients and hip internal rotation (HIR) (p50.002) in 88 patients were found in the LBP patients as compared to age and gender matched controls. Reduced HF was associated with significantly worse mODI (p50.04) and mHHS (p50.02). Reduced HIR was associated with significantly worse RM (p50.003). One or two positive provocative hip tests were found in 65 patients and 4 positive tests were found in 21 patients. ASLR was positive in 46 patients and early lumbopelvic motion with hip rotation was found in 77 patients. All outcome measures were found to be significantly worse (p values ranging p50.05 to p50.0001) in patients with positive provocative hip tests. Percentages of patients with abnormal radiograph measurements consistent with hip deformity included: 31.7% LCEA, 26.6% AI, 40% crossover sign, 76% alpha angle. OA was found in 18% of patients. Those with hip pincer deformity had significantly worse mODI (p50.01), RM (p50.002), and mHHS (p50.003). All outcome measures were significantly worse in patients with hip OA (p values ranging p50.02 to p50.0001). CONCLUSIONS: Many patients presenting with LBP had positive hip provocative tests, reduced HF and HIR and positive hip radiographic findings. These hip physical examination and radiographic findings in patients with LBP were associated with worse baseline pain and function scores as compared to patients with LBP without hip findings. Coexisting hip and spine disorders are more common than previously recognized and occur in patients without hip OA. It is important to examine the hip when evaluating patients with LBP to determine appropriate treatment. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.197
135. Pelvic Incidence in Patients with Hip Osteoarthritis Kris Radcliff, MD1, Ibrahim J. Raphael, MD1, Mohammad R. Rasouli, MD1, Christopher K. Kepler, MD, MBA2, Todd J. Albert, MD1, Javad Parvizi, MD, FRCS1; 1Rothman Institute, Philadelphia, PA, US; 2 New York, NY, US BACKGROUND CONTEXT: Hip osteoarthritis (HOA) is a major cause of pain and disability that results in considerable social and medical costs. Mechanics such as posture, alignment and orientation of the hips and the spinal column and the relationship between these factors have been implicated in the development of both hip and spine pathologies. PURPOSE: Assess the association of pelvic incidence with hip osteoarthritis. PATIENT SAMPLE: One hundred patients with moderate to severe hip osteoarthritis and 87 patients without hip osteoarthritis. OUTCOME MEASURES: Pelvic Incidence angle in patients with and without hip osteoarthritis. METHODS: Supine pelvis CT scans of 1,012 consecutive patients were collected. These patients were evaluated for various reasons; none were known to have HOA. Our first group consisted of 100 patients with
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
Proceedings of the NASS 27th Annual Meeting / The Spine Journal 12 (2012) 65S–80S moderate to severe HOA as per radiology reports. The second group included 87 patients with no evidence of HOA. Power analysis revealed the need for 77 patients per group to find a mean difference in PI of 5 or less between both groups. On the sagittal cut passing through the midline of the vertebral column, the PI was determined by measuring the angle formed by a perpendicular to the middle of the superior sacral endplate and the midpoint of the line joining the centers of the femoral heads. Two trained physicians independently measured PI angles, to account for inter-observer reliability. RESULTS: By averaging the PI of both observers, the group of patients with moderate to severe HOA had a mean PI of 56.47 6 13.86. The mean PI for the group of patients without signs of HOA was 55.67 6 8.41. An independent samples t-test revealed no significant difference between the PI values of moderate to severe and absent HOA groups (p50.630). Spearman’s correlation coefficient of 0.754 demonstrated a high inter-observer reliability. CONCLUSIONS: There was no difference in PI angle of HOA patients and ‘‘healthy’’ patients. Our measurements of patients without OA were almost identical to the reported normal PI values in the literature.HOA is not associated with PI angle, refuting the hypothesis made in previous studies, stating that elevated PI contributes to the future development of HOA. CT scan seems to be a reliable and accurate way of assessing pelvic incidence. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.198
136. The Symphysis in Patients with SI Joint Pain: A Pilot Study Stephan W. Becker, MD; IMSART Medimpuls, Vienna, Austria BACKGROUND CONTEXT: Sacroiliac (SI) joint pain and minimal-invasive therapies have recently become a matter of interest. However the diagnosis of SI pain is not based on a single examination, but represents a mosaic of clinical examination, CT and SI joint injections.As the pelvis is a three-dimensional structure, any changes of the sacro-iliacal joint should influence the other joints of the pelvis. PURPOSE: Investigation of the symphysis in SI joint patients in order to define possible additional methods to diagnose SI – joint pain. STUDY DESIGN/SETTING: Retrospective case control study. PATIENT SAMPLE: Twenty consecutive patients with clear SI joint pathology (confirmed by SI joint injections) versus 20 patients with back pain without SI joint pathology. OUTCOME MEASURES: Description and analysis of X-ray changes. METHODS: Anaylsis of rediological reports and independent assessment by 2 orthopedic surgeons. RESULTS: Overall, three different pathological types of the symphysis could be distinguished: osteoarthritic degeneration (type 1), subluxation (type 2) and fusion (type three). The verum group contained 17 women (mean age 61y) and 3 men (mean age 48y). Nineteen patients showed abnormalities of the symphysis with all women having either type 1 (7 patients) or type 2 (10 patients) changes. The men showed one normal joint, one type 1 and one type 3 change. Only 3 radiology reports mentioned the found changes in the verum group. Several patients in the verum group were treated with minimal-invasive fusion.The control group contained 16 female (mean age 69y) and 4 male patients (mean age 61y). Changes were found in 7 patients (5 type 1, 2 type 2, no type 3; 6 female and one male patient). No radiological report mentioned those changes. CONCLUSIONS: Unlike the SI – joint, the symphysis can be easily diagnosed on plain X-rays. Any changes of the symphysis are underreported in radiological reports. We found significantly more changes of the symphysis in patients with confirmed SI joint pain than in patients with back pain. Therefore the symphysis may represent another important piece in
69S
the mosaic of SI joint diagnosis. Due to the low number of patients we could not find a specific pattern of symphysis change in patients with SI joint pathology. FDA DEVICE/DRUG STATUS: IFuse (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2012.08.199
137. Can Sacroiliac Joint Aspiration Assist in Diagnosis? A Pilot Study Matthew W. Smuck, MD1, Ma.Agnes, Ith, MD2, S. Raymond Golish, MD, PhD3, Eugene J. Carragee, MD4, Lyly Cao Minh, MD5, Lewis S. Hanna, PhD6, Gaetano J. Scuderi, MD7; 1Menlo Park, CA, US; 2Stanford, Redwood City, CA, US; 3InMotion Clinic, Longview, WA, US; 4Stanford University School of Medicine, Redwood City, CA, US; 5Palo Alto, CA, US; 6Cytonics Corporation, Jupiter, FL, US; 7Jupiter, FL, US PURPOSE: Sacroiliac joint (SIJ) dysfunction is felt to be an increasingly recognized cause of low back pain (LBP). The aim of this investigation was to determine the viability of obtaining sample material for inflammatory cytokines in the SIJ of symptomatic patients which may assist in improving our efficacy. METHODS: Inclusion criteria included age O18, and no previous surgery on the SIJ. Patients were identified during the period of December 2010to September 2011. Participants were identified after physical exam (compression, FABER and Gaenslen tests) identified the SIJ as a likely cause of symptoms. At the time of injection, done fluoroscopically, upon introduction of the needle, 2 cc of physiologic saline was injected and then recovered and placed on ice for transport to a -80 C freezer, where kept until analysis. The concentration of the fibronectin aggrecan complex (FAC) and 15 cytokines/chemokines were measured using a multiplex immunoassay. The mediators included: FAC, IL-1b, IL1-RA, IL-6, Eotaxin, IFN-g(interferon gamma), MCP-1 (monocyte chemoattractant protein-1), MIP-1b PDGF-BB, RANTES, TNF-alpha and VEGF. Also we measured MMP-1, MMP-3, MMP-9. RESULTS: Thirteen patients underwent lavage and injection. Age range was 26-90 (mean 58.5). There were 10 females and 3 males. Seven right and 6 left. At 2 week fu 7/13 had ODI improvement of more than 20 points. IL-1ra appears to be elevated in patients that improved but we are underpowered. Volumes obtained were uniformly low and variable. Sampling the SIJ appears to be a valid technique that needs refining. CONCLUSIONS: Obtaining fluid from the SI joint is possible but variable. Better sampling methods need to be developed. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.200
138. Nonoperative Management of Coccydynia: A Comparative Study Comparing Three Methods Soumya Chakraborty, MBBS, MS; PGIMER, Chandigarh, India BACKGROUND CONTEXT: Coccydynia is a cause of morbidity worldwide. Various conservative options have been tried with success rate reaching up to 90%. PURPOSE: This study compares the role of manipulation alone, corticosteroid injection alone and combined manipulation and corticosteroid injection in the management of Coccydynia. STUDY DESIGN/SETTING: Prospective, randomized trial comparing three methods of treatment with follow up at 1 month and 1 year. PATIENT SAMPLE: Ninety-four patients (Jan 2007 to Dec 2009) with Coccydynia were selected on the basis of detailed history taking, clinical examination, and radiography.
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.