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Poster 36 Is the Lateral Jack-Knife Position Responsible for Cases of Transient Neuropraxia?
S194
had a very antalgic gait pattern. Right hip flexion and internal rotation reproduced right buttock and groin pain. Right hip internal rotation was limited to less than 5 degrees. Strength was 5/5 in the bilateral upper and lower limbs. He had weakness with stair climbing using the right leg. Reflexes were symmetric and there were no upper motor neuron signs. Setting: Outpatient orthopedic practice Results or Clinical Course: MRI of the lumbar spine showed moderate-to-severe lumbar spinal stenosis at L4-L5 and moderate-to-severe central canal stenosis at L2-L3. X-rays of the right hip were found to be normal. MRI of the right hip was ordered, showing a 5-cm mass involving the lesser trochanter, consistent with metastases. The patient was referred to orthopedic oncology and underwent a prophylactic intramedullary nailing of the right femur. He continues to improve with his ambulation and is undergoing additional treatment with oncology. Conclusions: We present a case of lumbar spinal stenosis with leg pain in the L2-L4 dermatome, which was eventually diagnosed as metastatic prostate tumor to the femur. Clinicians should be aware of the difference in symptoms between lumbar spinal stenosis and hip pathologies, including reduced hip range of motion, painful weight bearing, and absence of neurological involvement. Advanced imaging of the hip should be considered when there is suspicion for non-spinal cause of hip and leg pain.
Poster 36 Is the Lateral Jack-Knife Position Responsible for Cases of Transient Neuropraxia? Daniel A. Fung, MD (Orthopedic Pain Specialists, Santa Monica, CA, United States); Diana M. Molinares, MD; Timothy T. Davis, MD. Disclosures: D. A. Fung, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: The objective of this study is to assess if the lateral jack-knife surgical position alone can result in neurologic symptoms. Design: Randomized prospective study. Setting: Private Practice. Participants: Fifity volunteers. Interventions: Fifty healthy volunteers were randomly assigned to one of two study groups: RLD position, Group A, and 25 degree RLJK position, Group B. During the first visit a baseline knee extension and hip flexion 10-repetition maximum test (10max) was conducted. In the second visit, on the day of positioning, a sensory examination (Sense Test) was completed. Subjects were then placed in the assigned position for 60 minutes. Post-positioning (PostP) strength and sensory examinations completed immediately after positioning and at even time intervals after. A follow-up call was made to determine the duration of the symptoms 7 days after the second visit. Main Outcome Measures: 10-repetition maximum strength testing and light touch and pinprick sensory testing. Results or Clinical Course: 10max and Sense Test deficits in the non-dependent side (up side) were observed in 100% of the subjects in Group B (RLJK position) and no deficits were seen in Group A (RLD position). Statistically significant differences
PRESENTATIONS
(p value <.05) were found when comparing the PostP 10max between the two groups immediately and 60 minutes after positioning. Minimal deficits were seen in the dependent, right, extremity and there was no statistical difference in the two groups (p¼.15). Ninety-eight percent of Group B subjects exhibited abnormal PostP Sense Test in the non-dependent extremity. Ninety-two percent of Group B PostP Sense Test deficits in the L1 dermatome; 88% in L2 and 44% in L3. Statistically significant differences were observed between Group A and B between Base and PostP Sense Test, with L1 and L2 being the most affected dermatomes. Similar results were found in the light touch examination (p¼.0007). Conclusions: Twenty-five degrees of right lateral jack-knife positioning for 60 minutes results in neurapraxia of the nondependent lower extremity. Our results support the concept that lateral jack-knife position alone can contribute to postoperative neurologic symptoms observed in patients undergoing transpsoas surgical procedures where the jack-knife positioning is implemented.
Poster 37 The Inpatient Rehabilitation Performance of Paraneoplastic Cerebellar Degeneration Patients. Jack B. Fu, MD (MD Anderson Cancer Center, Houston, TX, United States); Vishwa Raj, MD; Arash Asher, MD; Jay Lee, PhD; Ki Y. Shin, MD. Disclosures: J. B. Fu, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: To evaluate the functional improvement of rehabilitation inpatients with paraneoplastic cerebellar degeneration. Design: Retrospective Review. Setting: Three tertiary referral based hospitals. Participants: Cancer rehabilitation inpatients admitted to three different cancer centers with a diagnosis of paraneoplastic cerebellar degeneration (n¼7). Interventions: Medical records were retrospectively analyzed for demographic, medical history, laboratory, discharge, and functional information regarding their inpatient rehabilitation. Main Outcome Measures: Functional Independence Measure (FIM). Results or Clinical Course: All 7 patients were white females. Median age was 62. Primary cancers included uterine adenocarcinoma, ovarian carcinoma, small cell lung cancer, and invasive ductal breast carcinoma. Mean Admission Total FIM Score was 61.0 (SD¼23.97). Mean Discharge Total FIM Score was 73.6 (SD¼29.35). The mean change in FIM was 12.6 (p¼.0018). Mean length of rehabilitation stay was 17.1 days. Mean Total FIM efficiency was 0.73. 5/7 (71%) patients were discharged home. 1/7 (14%) was discharged to a nursing home. 1/7 (14%) returned to the primary acute care service. Conclusions: This is the first study to demonstrate the functional performance of rehabilitation inpatients with paraneoplastic cerebellar degeneration. Despite the poor neurologic prognosis associated with paraneoplastic cerebellar degeneration, these patients made significant functional improvements on inpatient rehabilitation. When appropriate, inpatient rehabilitation should be considered. Further studies with larger sample sizes are needed.
had a very antalgic gait pattern. Right hip flexion and internal rotation reproduced right buttock and groin pain. Right hip internal rotation was limited to less than 5 degrees. Strength was 5/5 in the bilateral upper and lower limbs. He had weakness with stair climbing using the right leg. Reflexes were symmetric and there were no upper motor neuron signs. Setting: Outpatient orthopedic practice Results or Clinical Course: MRI of the lumbar spine showed moderate-to-severe lumbar spinal stenosis at L4-L5 and moderate-to-severe central canal stenosis at L2-L3. X-rays of the right hip were found to be normal. MRI of the right hip was ordered, showing a 5-cm mass involving the lesser trochanter, consistent with metastases. The patient was referred to orthopedic oncology and underwent a prophylactic intramedullary nailing of the right femur. He continues to improve with his ambulation and is undergoing additional treatment with oncology. Conclusions: We present a case of lumbar spinal stenosis with leg pain in the L2-L4 dermatome, which was eventually diagnosed as metastatic prostate tumor to the femur. Clinicians should be aware of the difference in symptoms between lumbar spinal stenosis and hip pathologies, including reduced hip range of motion, painful weight bearing, and absence of neurological involvement. Advanced imaging of the hip should be considered when there is suspicion for non-spinal cause of hip and leg pain.
Poster 36 Is the Lateral Jack-Knife Position Responsible for Cases of Transient Neuropraxia? Daniel A. Fung, MD (Orthopedic Pain Specialists, Santa Monica, CA, United States); Diana M. Molinares, MD; Timothy T. Davis, MD. Disclosures: D. A. Fung, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: The objective of this study is to assess if the lateral jack-knife surgical position alone can result in neurologic symptoms. Design: Randomized prospective study. Setting: Private Practice. Participants: Fifity volunteers. Interventions: Fifty healthy volunteers were randomly assigned to one of two study groups: RLD position, Group A, and 25 degree RLJK position, Group B. During the first visit a baseline knee extension and hip flexion 10-repetition maximum test (10max) was conducted. In the second visit, on the day of positioning, a sensory examination (Sense Test) was completed. Subjects were then placed in the assigned position for 60 minutes. Post-positioning (PostP) strength and sensory examinations completed immediately after positioning and at even time intervals after. A follow-up call was made to determine the duration of the symptoms 7 days after the second visit. Main Outcome Measures: 10-repetition maximum strength testing and light touch and pinprick sensory testing. Results or Clinical Course: 10max and Sense Test deficits in the non-dependent side (up side) were observed in 100% of the subjects in Group B (RLJK position) and no deficits were seen in Group A (RLD position). Statistically significant differences
PRESENTATIONS
(p value <.05) were found when comparing the PostP 10max between the two groups immediately and 60 minutes after positioning. Minimal deficits were seen in the dependent, right, extremity and there was no statistical difference in the two groups (p¼.15). Ninety-eight percent of Group B subjects exhibited abnormal PostP Sense Test in the non-dependent extremity. Ninety-two percent of Group B PostP Sense Test deficits in the L1 dermatome; 88% in L2 and 44% in L3. Statistically significant differences were observed between Group A and B between Base and PostP Sense Test, with L1 and L2 being the most affected dermatomes. Similar results were found in the light touch examination (p¼.0007). Conclusions: Twenty-five degrees of right lateral jack-knife positioning for 60 minutes results in neurapraxia of the nondependent lower extremity. Our results support the concept that lateral jack-knife position alone can contribute to postoperative neurologic symptoms observed in patients undergoing transpsoas surgical procedures where the jack-knife positioning is implemented.
Poster 37 The Inpatient Rehabilitation Performance of Paraneoplastic Cerebellar Degeneration Patients. Jack B. Fu, MD (MD Anderson Cancer Center, Houston, TX, United States); Vishwa Raj, MD; Arash Asher, MD; Jay Lee, PhD; Ki Y. Shin, MD. Disclosures: J. B. Fu, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Objective: To evaluate the functional improvement of rehabilitation inpatients with paraneoplastic cerebellar degeneration. Design: Retrospective Review. Setting: Three tertiary referral based hospitals. Participants: Cancer rehabilitation inpatients admitted to three different cancer centers with a diagnosis of paraneoplastic cerebellar degeneration (n¼7). Interventions: Medical records were retrospectively analyzed for demographic, medical history, laboratory, discharge, and functional information regarding their inpatient rehabilitation. Main Outcome Measures: Functional Independence Measure (FIM). Results or Clinical Course: All 7 patients were white females. Median age was 62. Primary cancers included uterine adenocarcinoma, ovarian carcinoma, small cell lung cancer, and invasive ductal breast carcinoma. Mean Admission Total FIM Score was 61.0 (SD¼23.97). Mean Discharge Total FIM Score was 73.6 (SD¼29.35). The mean change in FIM was 12.6 (p¼.0018). Mean length of rehabilitation stay was 17.1 days. Mean Total FIM efficiency was 0.73. 5/7 (71%) patients were discharged home. 1/7 (14%) was discharged to a nursing home. 1/7 (14%) returned to the primary acute care service. Conclusions: This is the first study to demonstrate the functional performance of rehabilitation inpatients with paraneoplastic cerebellar degeneration. Despite the poor neurologic prognosis associated with paraneoplastic cerebellar degeneration, these patients made significant functional improvements on inpatient rehabilitation. When appropriate, inpatient rehabilitation should be considered. Further studies with larger sample sizes are needed.