Peter Gonzalez

The Diagnostic Validity of Hip Provocation Maneuvers to Detect Intra-Articular Hip Pathology

To determine which hip provocation maneuvers best predict the presence of an intra‐articular hip pathology.

The Effects of Epidural Betamethasone on Blood Glucose in Patients with Diabetes Mellitus

To determine the effects of lumbosacral transforaminal and caudal epidural betamethasone injections on blood glucose levels in diabetic subjects. The hypothesis is that epidural steroid injections result in transient elevation of blood glucose levels in diabetic subjects.

Evidence-informed management of chronic low back pain with adjunctive analgesics.

The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.

Poster 273 Transient Quadriparesis and Cervical Instability in a College Football Player-A Case Report

destroys motor neurons. Mutations in the senataxin gene causes ALS4. This case report describes the use of ITB to treat the spasticity in a person with ALS4. Oral agents may be ineffective or poorly tolerated. ITB can provide excellent control of spasticity with less side effects than oral agents. Conclusions: ITB to treat spasiticty in ALS4, or Juvenile Onset ALS, has not been reported in the literature. ALS4 is a life-long disease and is slowly progressive (unlike classical ALS) and can be associated with signficant spasticity. People with ALS4 and spasticity should have ITB as an option; a test doses of ITB, or a trial , will determine if it will be effective. After implantation, careful titration based on effect may improve function and quality of life.

Poster 115: Final Needle Position on Lateral Fluoroscopic Image During Confirmed Intra-articular Sacroiliac Joint Injections: A Retrospective Review

Disclosures: K. Berry, None. Objective: To assess the needle position on lateral fluoroscopic images in unequivocal intra-articular sacroiliac joint (SIJ) injections. Design: Retrospective review. Setting: An academic spine center. Participants: 29 patients undergoing diagnostic SIJ injections. Interventions: Intra-articular SIJ injections. Main Outcome Measures: Final needle tip position on lateral imaging of confirmed intra-articular injections, as determined by a panel of trained spine interventionists. Final needle tip position was defined as posterior to the sacrum, in the posterior 50% of the sacrum, in the anterior 50% of the sacrum, or anterior to the sacrum. Results: None of the SIJ injections were posterior to the sacrum and only 3 of the 29 images were in the posterior 50% of the sacrum. The majority of the injections were in anterior portion of the sacrum, with 18 in the anterior 50% and 8 anterior to the sacrum. Calculated confidence intervals revealed a statistical significance between the anterior 50% group and the posterior 50% group. Conclusions: Varying depths may be required to access the synovial portion of the SIJ. We would postulate that more cephalad targeted injections may cannulate the mid portion of the SIJ and allow for more anterior or ventral placement of the needle within the SIJ and therefore a greater likelihood of an intra-articular contrast pattern on SIJ injection. Routine lateral views during fluoroscopically guided SIJ injections will help determine depth of final needle position and possibly increase rate of intra-articular contrast patterns.