(median 1 day). After 12 months all clinical effectiveness criteria improved clearly for both groups (VAS pain improvement: EXP 94%/BK 82%; ODI improvement; EXP 94%/BK 90%) without statistically significant differences between treatments. Radiographically differences between EXP and BK were statistically significant regarding anterior and middle height restoration in favor of EXP, as well as for kyphotic angle restoration (change in kyphotic angle: EXP +4.4°/BK −0.2°), whereas Cobb angle and Gardner angle restoration showed a tendency to be better in the EXP group without statistical significancy. For safety analysis the results were 1 asymptomatic C1 cement extravasation was reported (EXP), 4 subsequent fractures (3 adjacent: 1 after a fall that was con- sidered a SAE, 1 EXP, 1 BK), no second surgery for VCF and no device related adverse events. Five patients (16%) showed 6 AEs, 2 cases in the EXP group and 3 in the BK group, three of the AEs were considered serious. CONCLUSIONS: This expansive intravertebral implant and balloon kyphoplasty are safe and clinically effective treatments. Both procedures show rapid and marked clinical improvement in termos of pain (VAS), function (ODI) and quality of life (EQ-%D), which is in line with the results of other authors. However, regarding radiological parameteres such as vertebral height and kyphotic angle restoration, EXP is superior in the short term and after 1 year, which may also enhance the long-term results. FDA DEVICE/DRUG STATUS: Expansive intravertebral implant Spinejack, Vexim SA, France (Investigational/Not approved), kyphon balloon kyphoplasty, Medtronic, USA (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2016.07.520 P195. Guidelines for the Management of Patients with Spinal Cord Injury: The Type and Timing of Rehabilitation Anthony Burns, MD, MSc 1 , Jefferson Wilson, MD, PhD 2 , Bizhan Aarabi, MD, FACS, FRCSC 3 , Paul A. Anderson, MD 4 , Darrel S. Brodke, MD 5 , Kazuhiro Chiba, MD, PhD 6 , Joseph R. Dettori, MPH, PhD 7 , Julio C. Furlan, MD, PhD, MBA 8 , James S. Harrop, MD 9 , Langston T. Holly, MD 10 , Susan Howley 11 , Tara Jeji, MBA 12 , Sukhvinder Kalsi-Ryan, PT, MS, PhD 13 , Mark Kotter, MD, PhD 14 , Brian K. Kwon, MD, PhD, FRCSC 15 , Ralph Marino, MD, MS 9 , Allan Martin, MD 2 , Eric M. Massicotte, MD, FRCSC 16 , Geno Merli, MD 17 , James Middleton, MBBS, PhD 18 , Hiroaki Nakashima, MD 19 , Narihito Nagoshi, MD, PhD 13 , Katherine Palmieri, MD, MBA 20 , Mohammed F. Shamji, MD, PhD, FRCSC 16 , Anoushka Singh, PhD 2 , Andrea C. Skelly, PhD, MPH 7 , Lindsay Tetreault, PhD 21 , Albert J. Yee, MD, FRCSC 22 , Michael G. Fehlings, MD, PhD, FRCSC 13 ; 1 University Health Network, Toronto Rehabilitation Institute, Toronto, ON, Canada; 2 Toronto, ON, Canada; 3 University of Maryland Medical Center, Department of Neurosurgery, Baltimore, MD, US; 4 University of Wisconsin Orthopedics & Rehabilitation, Madison, WI, US; 5 University Orthopaedic Center, Salt Lake City, UT, US; 6 Department of Orthopaedic Surgery, National Defense Medical College, Tokyo, Japan; 7 Spectrum Research, Inc., Tacoma, WA, US; 8 Toronto Western Research Institute, Toronto, ON, Canada; 9 Thomas Jefferson University, Philadelphia, PA, US; 10 UCLA Neurosurgery, Santa Monica, CA, US; 11 Christopher Reeve Paralysis Foundation, Baltimore, MD, US; 12 Ontario Neurotrauma Foundation, Toronto, ON, Canada; 13 Toronto Western Hospital, Toronto, ON, Canada; 14 University of Cambridge, Cambridge, United Kingdom; 15 Blusson Spinal Cord Center, Vancouver, BC, Canada; 16 University of Toronto, Toronto, ON, Canada; 17 Thomas Jefferson University Hospital, Philadelphia, PA, US; 18 The University of Sydney (John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research), Sydney, NSW, Australia; 19 Nagoya University Graduate School of Medicine, Department of Orthopedic Surgery, Nagoya, Japan; 20 University of Kansas Hospital, Kansas City, KS, US; 21 University of Toronto, Oakville, ON, Canada; 22 Sunnybrook Health Sciences Centre, Toronto, ON, Canada BACKGROUND CONTEXT: Rehabilitation plays a central role in maxi- mizing function and facilitating community reintegration following a SCI. Despite this, many fundamental questions remain regarding the efficacy of various rehabilitation strategies. PURPOSE: The objective of this study is to develop guidelines that outline the appropriate type and timing of rehabilitation in patients with acute spinal cord injury (SCI). STUDY DESIGN/SETTING: Guideline Development Study. OUTCOME MEASURES: Neurological and functional recovery and quality of life. METHODS: A systematic review of the literature was conducted to address the following key questions: (1) Does the time interval between injury and commencing rehabilitation affect outcome? (2) What is the comparative ef- fectiveness of different rehabilitation strategies, including different intensities and durations of treatment? (3) Are there patient or injury characteristics that impact the efficacy of rehabilitation? (4) What is the cost-effectiveness of various rehabilitation strategies? A multidisciplinary guideline develop- ment group used this information, in combination with their clinical expertise, to develop recommendations for the type and timing of rehabilitation. The benefits and harms, financial impact, acceptability, feasibility and patient pref- erences of each recommendation were carefully considered. Based on GRADE, a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” RESULTS: The guideline development group consisted of spine neuro- and orthopaedic surgeons, neurologists, rehabilitation specialists, patient advo- cates, a critical care physician, a nurse and a researcher. The main conclusions from the systematic review included: (1) there was no difference between body weight supported treadmill training and conventional rehabilitation with respect to improvements in FIM-L and LEMS scores, the distance walked in 6 minutes or gait velocity over 15.2 meters; (2) functional electric stim- ulation resulted in slightly better FIM Motor, FIM Self-Care and SCIM Self- Care subscores compared with conventional occupational therapy; and (3) there were no clinically important differences in maximal lean test, maximal sideward reach test, T-shirt test or the Canadian occupational performance measure between unsupported sitting training and standard in-patient reha- bilitation. Our recommendations were: (1) rehabilitation be offered to patients with acute spinal cord injury when they are medically stable and can tol- erate required rehabilitation intensity; (2) offering body weight support treadmill training as an option for ambulation training in addition to con- ventional overground walking, dependent on resource availability, context and local expertise; (3) individuals with acute and subacute cervical SCI be offered FET as an option to improve hand and upper extremity function; and (4) based on the absence of any clear benefit, we suggest not offering additional training in unsupported sitting beyond what is currently incor- porated in standard. CONCLUSIONS: These guidelines should be implemented into clinical prac- tice to improve outcomes and reduce morbidity in patients with SCI by promoting standardization of care, decreasing the heterogeneity of manage- ment strategies and encouraging clinicians to make evidence-informed decisions. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.521 P196. Traumatic Cervical Spine Injuries in Older Adults Anthony Asemota, MD; Baltimore, MD, USA BACKGROUND CONTEXT: Cervical spine (C-spine) injuries cause sig- nificant morbidity and mortality among the elderly. Although the population of older adults aged ≥65 years in the United States is expanding, recent es- timates of the burden and outcome of C-spine injury are lacking. PURPOSE: Quantify the burden of C-spine injury in older adults. De- scribe patterns and trends in admission, treatment, and outcome. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: Data was obtained from the Nationwide Inpatient Sample 2001–2010. OUTCOME MEASURES: Admission rates, Inpatient charges, Length of stay and mortality. S336 NASS 31 st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337 Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables.Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.