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Poster 172 A Novel Percutaneous Approach for Symptomatic Lumbar Facet Cystotomy Under Fluoroscopic Guidance
S148
Abstracts / PM R 7 (2015) S83-S222
Results or Clinical Course: Based on the MRI findings, she was referred to neurosurgery and underwent L5/S1 laminectomy. Intraoperatively, these lesions were associated with several nerve roots. The extramedullary lesion was sent to pathology and was found to be positive for S100 protein immunostain, strongly indicative of a tumor derived from Schwann cells. At 2 month follow up, the patient noted significant improvement of her function and radicular pain. Discussion: Schwannomas are slow growing benign nerve sheath tumors. Schwannomatosis has been described as a distinct tumor syndrome separate from Neurofibromatosis. It is characterized by presence of Schwann cell hyperplasia. The dominant symptom is pain which worsens as the schwannoma enlarges, and compresses nerves and adjacent tissues. Conclusion: As in this case, the goal of surgery is to obtain a diagnosis as well as to provide symptomatic relief. However, complete surgical resection is generally not undertaken if there are multiple lesions throughout the spinal cord and/or cauda equina. Treatments for multiple progressive lesions primarily include radiation. The patient was also referred to medical genetics for further work-up.
Poster 171 Associations between Low Back Pain and Movement Patterns (B-PAM): A Prospective Registry Protocol Mehul J. Desai, MD, MPH (Minnesota Medical Advanced Pain Specialists, Maple Grove, MN, United States), Meagan Blackburn, PT Disclosures: M. J. Desai: I Have No Relevant Financial Relationships To Disclose. Objective: A recent systematic review of lumbo-pelvic movement identified reduced lumbar range of motion, proprioception and decreased speed of movement among subjects with low back pain (LBP). Unfortunately, it is not known whether these deficits existed prior to the onset of LBP (Laird 2014). In clinical practice, measurement of movement traditionally involves subjective observation and measurement often limited in terms of validity and accuracy. Recent advances in inertial sensor technology have profoundly improved our ability to measure both simple and complex movement. These include measurements of static postures, simple dynamic movements within a clinical setting, work or home setting. We propose to utilize the DorsaVi VMove system (Melbourne, Victoria, Australia) to establish a registry of movement data for LBP patients with age and gender matched healthy controls. The registry data would allow us to describe movement in these patients and evaluate the relationship between movement and various other factors, and evaluate the effectiveness of interventions for LBP. Design: Prospective, registry. Setting: Private pain medicine and physical therapy practice. Participants: 200 age, gender matched subjects with and without LBP between the ages of 18-65. Interventions: Measurement of movement utilizing DorsaVi VMove. Main Outcome Measures: Inertial sensors measurements(standing, flexion, extension, lateral flexion right/left, pelvic tilt in standing, usual sitting posture, poor sitting posture, good sitting posture, pelvic tilt in sitting)Roland-Morris Disability QuestionnaireNumerical Pain Scales for pain for average leg and back pain over last 7 daysBrief Pain Inventory Patient Health Questionnaire (PHQ)-4 Depression and Anxiety ScreenEuroQol-5D. Results or Clinical Course: We expect to report the results of our investigation as stratified by those with LBP as compared to those without LBP. Conclusion: This registry will elucidate the movement patterns of subjects with LBP while also assessing and comparing these patterns to
age and gender matched controls without LBP. We may provide the basis for evaluating the efficacy of treatments and interventions while improving the understanding of movement patterns for those with LBP. Further the economic impact and value proposition of this system will be further investigated as a means to more efficient evaluation of patients with LBP.
Poster 172 A Novel Percutaneous Approach for Symptomatic Lumbar Facet Cystotomy Under Fluoroscopic Guidance Marissa Dombovy-Johnson, BS (Rochester Regional Health System, Rochester, NY, United States), Hemant Kalia, MD, MPH Disclosures: M. Dombovy-Johnson, No Answer Case Description: A 56-year-old woman presents to our outpatient spine center with chief complaint of progressively worsening right lower extremity neuropathic and radicular symptoms along the L5 distribution which started insidiously without any antecedent trauma. She denies any specific aggravating or relieving factors associated with her pain. MRI Lumbar Spine without contrast revealed bilateral L4-5 and L5-S1 facet arthropathy with right L4-5 Facet cyst impinging on right L5 nerve root in the lateral recess. She reported no significant improvement on gabapentin 600mg TID. Program Description: Informed consent was obtained for a trial of percutaneous facet cystotomy. She was placed in prone position and Right L4-5 facet joint was localized under oblique fluoroscopic view. 25G 1.5inch needle was used to inject 1% lidocaine along the needle entry site. A 22G 3.5inch needle was used to access the superior 1/3rd portion of the L4-5 facet joint in the oblique view. 3ml of Omnipaque contrast was used to fill in the cyst. Once the cyst was clearly visible and filled with contrast, an 18G Touhy needle was used to access the cyst using classic interlaminar approach under AP fluoroscopic guidance and LOR technique. Setting: Oupatient community based clinic. Results or Clinical Course: Successful percutaneous cystotomy was achieved with our double needle approach. Patient reported almost complete resolution in her symptoms in our post-procedure area. She was followed at regular intervals of 2 weeks, 1 and 3 months respectively post-procedure. She continues to report complete resolution of her radicular symptoms. Discussion: Traditionally, single needle approach has been widely used for percutaneous cyst rupture with a failure rate of 25% and recurrence rate of 50%. Our patient continues to report complete resolution of her radicular symptoms 3 months post procedure. We hypothesize that the two needle approach may be more effective in juxtaarticular facet cysts as compared to single needle. Conclusion: We hereby present a unique approach to target the symptomatic facet cysts percutaneously under fluoroscopic guidance in an outpatient setting. More data are needed to comment and analyze the success rate of double needle approach compared to conventional single needle one.
Poster 173 A Prospective, Randomized, Multi-Center, Open-Label Clinical Trial Comparing Intradiscal Biacuplasty to Conservative Therapy for Discogenic Lumbar Back Pain Mehul J. Desai, MD MPH (Minnesota Medical Advanced Pain Specialists, Maple Grove, MN, United States), Leonardo Kapural, MD PhD, Jeffrey Petersohn, MD, Ricardo Vallejo, MD, Nagy Mekhail, MD PhD, Robert Menzies, DO, Michael Creamer, MD, Michael Gofeld, MD Disclosures: M. J. Desai: I Have No Relevant Financial Relationships To Disclose.
Abstracts / PM R 7 (2015) S83-S222
Results or Clinical Course: Based on the MRI findings, she was referred to neurosurgery and underwent L5/S1 laminectomy. Intraoperatively, these lesions were associated with several nerve roots. The extramedullary lesion was sent to pathology and was found to be positive for S100 protein immunostain, strongly indicative of a tumor derived from Schwann cells. At 2 month follow up, the patient noted significant improvement of her function and radicular pain. Discussion: Schwannomas are slow growing benign nerve sheath tumors. Schwannomatosis has been described as a distinct tumor syndrome separate from Neurofibromatosis. It is characterized by presence of Schwann cell hyperplasia. The dominant symptom is pain which worsens as the schwannoma enlarges, and compresses nerves and adjacent tissues. Conclusion: As in this case, the goal of surgery is to obtain a diagnosis as well as to provide symptomatic relief. However, complete surgical resection is generally not undertaken if there are multiple lesions throughout the spinal cord and/or cauda equina. Treatments for multiple progressive lesions primarily include radiation. The patient was also referred to medical genetics for further work-up.
Poster 171 Associations between Low Back Pain and Movement Patterns (B-PAM): A Prospective Registry Protocol Mehul J. Desai, MD, MPH (Minnesota Medical Advanced Pain Specialists, Maple Grove, MN, United States), Meagan Blackburn, PT Disclosures: M. J. Desai: I Have No Relevant Financial Relationships To Disclose. Objective: A recent systematic review of lumbo-pelvic movement identified reduced lumbar range of motion, proprioception and decreased speed of movement among subjects with low back pain (LBP). Unfortunately, it is not known whether these deficits existed prior to the onset of LBP (Laird 2014). In clinical practice, measurement of movement traditionally involves subjective observation and measurement often limited in terms of validity and accuracy. Recent advances in inertial sensor technology have profoundly improved our ability to measure both simple and complex movement. These include measurements of static postures, simple dynamic movements within a clinical setting, work or home setting. We propose to utilize the DorsaVi VMove system (Melbourne, Victoria, Australia) to establish a registry of movement data for LBP patients with age and gender matched healthy controls. The registry data would allow us to describe movement in these patients and evaluate the relationship between movement and various other factors, and evaluate the effectiveness of interventions for LBP. Design: Prospective, registry. Setting: Private pain medicine and physical therapy practice. Participants: 200 age, gender matched subjects with and without LBP between the ages of 18-65. Interventions: Measurement of movement utilizing DorsaVi VMove. Main Outcome Measures: Inertial sensors measurements(standing, flexion, extension, lateral flexion right/left, pelvic tilt in standing, usual sitting posture, poor sitting posture, good sitting posture, pelvic tilt in sitting)Roland-Morris Disability QuestionnaireNumerical Pain Scales for pain for average leg and back pain over last 7 daysBrief Pain Inventory Patient Health Questionnaire (PHQ)-4 Depression and Anxiety ScreenEuroQol-5D. Results or Clinical Course: We expect to report the results of our investigation as stratified by those with LBP as compared to those without LBP. Conclusion: This registry will elucidate the movement patterns of subjects with LBP while also assessing and comparing these patterns to
age and gender matched controls without LBP. We may provide the basis for evaluating the efficacy of treatments and interventions while improving the understanding of movement patterns for those with LBP. Further the economic impact and value proposition of this system will be further investigated as a means to more efficient evaluation of patients with LBP.
Poster 172 A Novel Percutaneous Approach for Symptomatic Lumbar Facet Cystotomy Under Fluoroscopic Guidance Marissa Dombovy-Johnson, BS (Rochester Regional Health System, Rochester, NY, United States), Hemant Kalia, MD, MPH Disclosures: M. Dombovy-Johnson, No Answer Case Description: A 56-year-old woman presents to our outpatient spine center with chief complaint of progressively worsening right lower extremity neuropathic and radicular symptoms along the L5 distribution which started insidiously without any antecedent trauma. She denies any specific aggravating or relieving factors associated with her pain. MRI Lumbar Spine without contrast revealed bilateral L4-5 and L5-S1 facet arthropathy with right L4-5 Facet cyst impinging on right L5 nerve root in the lateral recess. She reported no significant improvement on gabapentin 600mg TID. Program Description: Informed consent was obtained for a trial of percutaneous facet cystotomy. She was placed in prone position and Right L4-5 facet joint was localized under oblique fluoroscopic view. 25G 1.5inch needle was used to inject 1% lidocaine along the needle entry site. A 22G 3.5inch needle was used to access the superior 1/3rd portion of the L4-5 facet joint in the oblique view. 3ml of Omnipaque contrast was used to fill in the cyst. Once the cyst was clearly visible and filled with contrast, an 18G Touhy needle was used to access the cyst using classic interlaminar approach under AP fluoroscopic guidance and LOR technique. Setting: Oupatient community based clinic. Results or Clinical Course: Successful percutaneous cystotomy was achieved with our double needle approach. Patient reported almost complete resolution in her symptoms in our post-procedure area. She was followed at regular intervals of 2 weeks, 1 and 3 months respectively post-procedure. She continues to report complete resolution of her radicular symptoms. Discussion: Traditionally, single needle approach has been widely used for percutaneous cyst rupture with a failure rate of 25% and recurrence rate of 50%. Our patient continues to report complete resolution of her radicular symptoms 3 months post procedure. We hypothesize that the two needle approach may be more effective in juxtaarticular facet cysts as compared to single needle. Conclusion: We hereby present a unique approach to target the symptomatic facet cysts percutaneously under fluoroscopic guidance in an outpatient setting. More data are needed to comment and analyze the success rate of double needle approach compared to conventional single needle one.
Poster 173 A Prospective, Randomized, Multi-Center, Open-Label Clinical Trial Comparing Intradiscal Biacuplasty to Conservative Therapy for Discogenic Lumbar Back Pain Mehul J. Desai, MD MPH (Minnesota Medical Advanced Pain Specialists, Maple Grove, MN, United States), Leonardo Kapural, MD PhD, Jeffrey Petersohn, MD, Ricardo Vallejo, MD, Nagy Mekhail, MD PhD, Robert Menzies, DO, Michael Creamer, MD, Michael Gofeld, MD Disclosures: M. J. Desai: I Have No Relevant Financial Relationships To Disclose.