S138 PRESENTATIONS

No. 225 Enfermedad De Baastrup: Lumbalgia MecánicaCrónica.Idoya Barca Fernadez; Concepcion Cuenca Gonzalez;Maria Fernanda; Berzal Cantalejo;Ana Maria Herranz Torrubiano.

Location: Hospital Clinic, San Carlos, Madrid, España. Dis-closure: None. Setting: Regional hospital and nacional reference. Firstlevel hospital. Patient: Paciente de 83 años con lumbalgia mecánica pro-gresiva de años de evolución sin clínica de claudicación ni atrapamientoradicular derivada desde reumatología. Case Description: Antecedentespersonales: no alergias medicamentosas conocidas HTA dislipemia hipotir-oidismo diabetes mellitus no insulín dependiente síndrome depresivopolimialgia reumática con afectación periférica y osteopenia. Tratamientofarmacológico con inmunosupresores (metrotexate) calcio vitamina Dbifosfonatos metamizol y paracetamol. Exploración física: apofisalgiaslumbares bajas con leve dolor musculatura paravertebral bilateral. Dolor a laextensión columna lumbar. Lassegue bragard y puntos ciáticos negativos.Desnivel pélvico derecho que compensa con alza de 1 cm. Marcha en puntasy talones conseguida con ayuda de una persona por inestabilidad. Resto dela exploración normal. RX columna lumbar: severos cambios degenerativoscon disminución de los espacios intervertebrales a diferentes nivelesosteofitos anterolaterales muy prominente y afectación degenerativa severade las articulaciones interapofisarias lumbares bajas compatible con enfer-medad de Baastrup. Results: Tras su valoración se pauta tratamiento conmagnetoterapia y ajuste tratamiento farmacológico analgésico así comomedidas higiénico posturales (disminución dolor con la flexión empeor-amiento con la extensión) con mejoría de la clínica (eva inicial 6/ final 2;Oswestry disability test inicial 42%/ final 19%). No se realiza infiltración deanestésicos locales entre apófisis dolorosas ni resección parcial de las apófisisespinosas dada la edad de la paciente.discussion: la enfermedad de baas-trump es una causa poco conocida de dolor lumbar con afectación degen-erativa de la apófisis espinosas (l3-l4 y l4-l5) y formación de unapseudoarticulación entre las apófisis espinosas lumbares y rotura-degener-ación del ligamento interespinoso a menudo asociada a una hiperlordosislumbar. Conclusions: La enfermedad de Baastrup debe sospecharse parapoder ser diagnosticada. Se localiza en línea media se reproduce con lapalpación y se exacerba con la.

No. 226 Efficiency of the Blockade Paraespinoso and DryAgujamiento in Low Back Pain Treatment at Police.Astrid Cecilia Bernaola Cuadros;Leonid Richard Bernaola Cuadros (Hospital, Lima 2011).

Objective: To determine the therapeutic efficacy of paraespinosoblockade and dry agujamiento in treating low back pain in patients at thePolice Hospital, Lima 2011. Design: Study type: observational, descrip-tive, retrospective cross. Demographic data were collected and therapeuticmedical records of patients who received paraespinoso blockade and dryagujamiento 1-4 sessions LNS, PNP hospital during the period fromFebruary to July 2011. Location: Hospital De Police Lima, Peru.Participants: 112 patients; male (n ¼ 56) and female (n ¼ 56). Inter-vention: Not applicable. Level of Evidence: Level 1. MainOutcome Measures: Visual analog scale (EVA) of safety, percentage ofsubjects able to learn the skills, the time required, and subjective difficultyscores (EVA 0: success (no pain); EVA 1-3: better; EVA > 4: failure).Results: Of 112 patients 50% had received paraespinoso blockade 28.6%treatment success EVA: painless; 64.3% improvement EVA: 1-3. In dryagujamiento improvement was obtained in 92.9% with EVA: 1-3, and inboth methods of treatment the percentage of failure is no predominance7.1% according to sex. Paraespinoso blockade pain relief: 7.1% in onesession, 21.4% in two, 42.9% and 28.6% in three and four, respectively. Indry agujamiento: 78.6% in three sessions and 21.4% in four, pain relief notbeing obtained in first and second sessions. Conclusions: Paraespinosoblockade is effective short-term in relation to dry agujamiento to reduce theprevalence of moderate to severe low back pain. Therapeutic success was

observed from the first session compared to the third session of pain reliefwith dry agujamiento. This type of treatment can be applied to other healthfacilities nationwide.

No. 227 Proposal of a New Physical Therapy Scheme forAssessment and Rehabilitation Treatment of SystemicNephrogenic Fibrosis: A Case Report.Camacho Honorio Arroyo Galo Eduardo;Nakazato Nakamine Tomás Saneo.

Patient: 65-year-old woman with systemic nephrogenic fibrosis (SNF).Case Description: Patient with severe generalized pain and mobilityrestriction despite drug treatment with opioids adjuvants and local anes-thetics. We proposed a scheme for assessment and rehabilitation with 6 keyfeatures: 1) pain, 2) joints range of movement (ROM), 3) muscle strength(MS), 4) sensitivity and proprioception (S&P), 5) activities of daily living,walking, and moving (ADLW&M), 6) complications. Initial assessment (ICFcodes in parenthesis): 1) VAS 10 (B280.4), 2) mean ROM 48.7% (B710.3),3) mean MS 3 (B730.3), 4) S&P altered (B265.2 B260.2), 5) ADLW&Mcomplete difficulty (caring for body parts D520.4, dressing D540.4, eatingD550.4, walking, and moving D469), 6) no complications. Physical therapytreatment (PTT) prescribed: 1) pain management: thermotherapy andTENS, 2) improve ROM: passive and active-assisted mobilizations, 3)improve MS: isometrics, 4) improve S&P: textures, stimulation, 5) improveADLW&M: exercises for the upper extremities, 6) prevent complications:respiratory exercises and skin care. Results: Final assessment after 36sessions of PTT 3 times/week: 1) VAS 9 (mild improvement B280.3), 2)ROM 73.3% (good improvement B710.2), 3) FM equal, 4) S&P equal, 5)mild improvement in some ADLW&M activities (d550.3, d469.3), 6) nocomplications. Discussion: SNF is a rare condition presented in patientswith chronic kidney failure in dialysis exposed to gadolinium for IRMstudies. They develop pain and progressive loss of mobility. To ourknowledge, this is the first report of PTT for this condition and using theproposed scheme the patient improved in 3 of the 6 features evaluated(pain, ROM and ADLW&M) with the remaining 3 maintained withoutdeterioration. Conclusion: PTT improved the condition of this patientwith SNF. The use of this new scheme allowed us to arrange a carefulassessment and treatment with greater objectivity in the evaluation of therehabilitation outcomes.

No. 230 Therapeutic Effects of Intraarticular Injection WithBotulinum Toxin Type A in Advanced Gonarthrosis.Carmen Eudelia Cortés Corral; Lilia Isabel; Correa Márquez;María Yolanda; Zambrano Muñoz; Alejandra Méndez Gómez.

Objective: To test the hypotheses that the use of intra-articular injectionwith botulinum toxin type A on the knee has therapeutic effects for painmanagement in advanced knee osteoarthritis. Design: Quasi-experimentalstudy. Setting: Pain management in advanced knee osteoarthritis.Participants: 39 patients from the Rehabilitation Department in CentroMédico de Occidente with knee osteoarthritis grade 3 and 4 according to theKellgren-Lawrence classification were recruited. Interventions: 100 unitsof botulinum toxin type A were reconstituted in 1cc of saline solution.Patients received an injection with a unique dose in one point at the affectedknee joint. Main Outcome Measures: Patients were evaluated before,and 4, 8, and 12 weeks after the application and were assessed with theWestern Ontario and MacMaster Universities Osteoarthritis Index(WOMAC), pain visual analog scale (PVAS), relief scale (RS), goniometry(GM), and the time up and go test (TUG) at each valuation. A statisticalanalysis was performed with the SPSS program v. 20.0. Results: Withinthe 39 studied patients 28.2% were among 66-70 years old correspondingto the highest frequency with a Kellgren-Lawrence scale where the majoritywere grade 3. 67% of the patients were female, and 97% of the subjects werediagnosed with obesity and overweight. Improvement was analyzed withPVAS and RS showing pain reduction when comparing the initial (14.2�16.8) with the final measure (25 � 17.2) score with a p value <0.001.Measuring functional status was performed by WOMAC, TUG, and GM

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through t Student we observed p <0.001 comparing initial and final statusin all scale scores. Conclusion: Intra-articular injection with botulinumtoxin type A is a therapeutic option for pain management in patients withadvanced knee osteoarthritis.

No. 231 Connotative Meaning of the Concepts of Lumbagoand Sciatica in Patients With Chronic Lumbar Pain Througha Model of Natural Semantic Network (RSN).Eva Cruz Medina; Roberto Coronado Zarco, MSc;Salvador Israel; Macías Hernández; Aurelia Arellano Hernández.

Objective: To identify the connotative meaning of “lumbago” and “sciatica”with a RSN in patients with lumbar spine pathology. Design: Cross sectionalstudy. Settings: Servicio de rehabilitación de columna México DistritoFederal. Participants: A total of 203 surveys were applied to the servicepatients: 111 women and 93 men, with a mean age of 44.4 years. MainOutcome Measures: In the survey were provided in the stimulus“lumbago” and “sciatica” words and asked patients to relate to other 5 wordsfrom arbitrarily form and then rank them in order of importance. Frequency ofmention (J) was determined group consensus (C10), semantic memoryassociation, semantic weight (M), and percentage of defining words.Results: Value J: 164 for lumbago, 195 for sciatica. C10: 33.1 for lumbago, and26.9 for sciatica. ValueM: lumbago (pain 1793, spine 623, back 466, discomfort405, lumbar 264); sciatica (pain 1573, nerve 947, leg 560). Median: 14.6lumbago 18.0/sciatica. Range: 9.2-88.2 lumbago / sciatica 14.7-119 (p¼ 0.315U ¼ 36). Lumbago PV / S (median 14.4/13.8 rank 10.8-88.3/8.9-86.6 (p ¼0.684; U ¼ 44) sciatica PV / S (median 7.4/6.9 rank 8.1-46.1/5.1-42.1 (p ¼0.436 U¼ 39).Conclusion: There is no difference in the conceptualizationof the terms. To modify this conceptualization emphasizing patient educationwill promote behavioral changes that improve adherence to treatment.

No. 234 Thoracic Vertebral Fracture After a Back Massage:A Case Report.Ayca Uran; Yasin Demir; Umut Guzelkucuk; Koray Aydemir.

Setting: 200-bed rehabilitation center. Patient: A 59-year-old man withback pain. Case Description: A 59-year-old patient presented to ourhospital with complaints of acute back pain. He stated that his pain hadstarted the day after a massage therapy. There was no history of trauma orfalls. Physical examination demonstrated normal range of motion of thecervical and lumbar spine. Tenderness was detected over the paravertebralmuscles and the spinous processes of vertebrae from T5 to T7 levels onpalpation. Assessment/Results: Routine laboratory tests revealed a crea-tine kinase (CK) level of 536 U/l. The serum concentration of C reactiveprotein (CRP) was 10.3 mg/dl, and the erythrocyte sedimentation rate was30 mm/h. X ray examination was normal. Topical analgesic was prescribedas medical treatment; bed rest and hydration were recommended. Thoraciccomputed tomography (CT) was also planned for the patient. Controllaboratory tests showed increase of CK and CRP levels to 800 U/l and 15mg/dl, respectively. Thoracic CT findings were compatible with a thoracicvertebral fracture at the level of T7. The conservative treatment includedbrace and physical therapy programme was applied to the patient. After thephysical therapy programme VAS pain score was decreased from 100 mm to30 mm. Discussion: Fracture is a serious and rare complication ofmassage therapy. It can be a result of low energy trauma. Clinicians shouldbe aware of this clinical entity especially in patients with elevated CK levelsafter the massage application. The diagnosis should be confirmed by clinicaland radiological assessments.

No. 237 Patients With Degenerative Spondylolisthesis WhoChose to Have Surgery Had Significant Instability and MoreFatty Infiltration in Erector Spinae.Sibel Demir-Deviren; Emel Ece Ozcan-Eksi; Shane Burch;Sigurd Berven.

Disclosure: None. Objective: To compare the lumbar paraspinalmuscles in subjects with degenerative spondylolisthesis (DS) who chose to

have surgery with those who did not. Design: Retrospective study onprospectively collected data. Setting: University based spine center. Par-ticipants: Seventy subjects with DS (mean age 69.20�11.09 years;female:48 male:22). Main Outcome Measures: We measured atrophyand fatty infiltration in lumbar multifidus and erector spinae muscles on T1-weighted axial MR images. The expected cross-sectional area and functionalCSA (FCSA) of the muscles were measured by using free hand technique onOsirix�. Then the percentage of muscle atrophy was calculated. Fattyinfiltration was graded by using Goutallier and quartile classifications. Facetjoint widening was determined as the largest distance between the apparentarticular surfaces. Results: The groups were the same in age (p>0.05). Thesurgery group had significantly less multifidus atrophy at all disc levels andalso had significantly less erector spinae atrophy at all disc levels except L5-S1 (p<0.035). The surgery group had higher fatty infiltration scores for theerector spinae at L5-S1 (p<0.002) and significantly more facet jointwidening than the non-surgical group (p¼0.036). The facet joint wideningwas seen in 26.31% and 60.71% of non-surgical and non-surgical subjects,respectively. Conclusions: The subjects with DS who chose to havesurgery had significant instability and more fatty infiltration in erector spinaeat L5-S1. We think the surgical group had significantly less atrophy inmultifidus and erector spinae muscles as a result of instability which ledmuscles to work more to stabilize the spondylolisthesis. More studies areneeded to identify whether the patients with unstable DS with fatty infil-tration in paraspinal muscles are the patients who would benefit the mostfrom the surgical treatments.

No. 238 The Effect of Modic 1 Changes on the ClinicalOutcomes of Patients With Disc Herniation.Sibel Demir-Deviren; Emel Ece Ozcan-Eksi; Sigurd Berven;Jeffrey Lotz.

Disclosure: None. Objective: To determine the effect of Modic 1changes on the clinical outcomes in subjects with disc herniation (DH) whounderwent lumbar discectomy. Design: Retrospective study on prospec-tively collected data. Setting: UCSF Spine Center. Participants: Nine-teen subjects (mean age 39.08�8.96 years) with DH: 1) 7 subjects withModic 1; 2) 12 subjects without Modic changes. Main OutcomeMeasures: We measured visual analogue scale (VAS) and Oswestrydisability index (ODI) before and 6 months after the surgery. Modic changeswere evaluated on the MRI. Level of Evidence: II. Results: The groupswere similar in age and gender (p>0.05). The subjects without Modicchanges (44.66�21.66) were more disabled than those with Modic 1(24.57�13.45) at baseline (p¼0.023). The subjects with Modic 1 hadsignificantly more improvement in pain (70.75%) than subjects withoutModic changes (29.30%) (p¼0.010). The subjects with Modic 1(62.54�48.84%) had more improvement in disability than those withoutModic changes (-2.03�80.26%) even though it was not statistically signif-icant. Two subjects (28.57%) with Modic 1 developed discogenic pain withModic 1 without reherniation 33 months after surgery. One of themunderwent fusion at the level of the discectomy. One subject without Modicchanges (8.33%) developed reherniation in 4 months and underwent dis-cectomy. Conclusions: Subjects with Modic 1 had more improvement inpain than subjects without Modic changes at 6 months after the surgeryeven though subjects without Modic changes were more disabled at thebaseline. However more subjects with Modic 1 developed discogenic painafter discectomy comparing to subjects without Modic changes. Furtherprospective studies need to be done to find out the effect of Modic 1 bonemarrow changes on the prognosis of disc herniation and discectomy.

No. 240 Is It Worthwhile to Measure Bone Quality in PatientsWith Adolescent Idiopathic Scoliosis.Du Qing; Zhou Xuan; Chen Peijie.

Objective: The objectives of this study were to compare bone quality(speed-of-sound [SOS] and Z-scores) between female adolescent idiopathicscoliosis (AIS) patients and controls using quantitative ultrasound exami-nation. Design: Controlled study. Setting: Teaching tertiary general