CONCLUSIONS: In this study, increased extracellular matrix production and cell proliferation with no induction of discal cellular apoptosis was observed in the lumbar IVD after a 3 week running regimen in a rodent model, suggesting that regular exercise may have a stimulative effect on cells and matrix production. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.035 Wednesday, November 11, 2009 2:05–3:05 PM Concurrent Session 2: Spinal Injections/ Interventional Treatment 29. Selective Nerve Root Injections Can Prevent the Need for Surgery in Patients Suffering from Lumbar Disc Herniations Neil Manson, MD, Melissa Mckeon, MSC, Edward Abraham, MD; Canada East Spine Centre & Atlantic Health Sciences Corporation, Saint John, New Brunswick, Canada BACKGROUND CONTEXT: The median Orthopaedic surgery wait time in Canada is 36.7 weeks (Esmail 2008), thus there is a need to find alter- native treatments for pathologies such as lumbar disc herniations (LDH). The literature has demonstrated that selective nerve root injections (SNRI) are able to alleviate radicular symptoms caused by LDH (Riew 2006) and may be beneficial as an alternative to surgery. Therefore it is necessary to determine whether SNRIs provide significant symptom resolution alleviat- ing the need for surgery, or to determine if their success is transient and prolongs the time to surgery. PURPOSE: To evaluate the success of SNRI in patients suffering with LDH. STUDY DESIGN/SETTING: A retrospective chart review. PATIENT SAMPLE: 91 patients diagnosed with LDH who received SNRIs between Sept 2006 and July 2008. Criteria for referral to SNRI were patients who had exhausted non-operative measures and who wished to proceed with surgery. OUTCOME MEASURES: Patient demographics, diagnosis, Worker’s Compensation status, spinal levels and medication injected, treatment/ outcome, and time from referral to treatment were evaluated. The pri- mary outcome measure is the need for surgery versus the avoidance of surgery. METHODS: A retrospective chart review was used to determine the suc- cess of the SNRI at a 6 week follow-up visit. SNRI success was determined by self-reported pain and symptom reduction. Minitab software was used to assess statistical significance of the outcome measures. RESULTS: Time from family physician referral to injection was 123 (688) days; no significant differences in wait list times were found be- tween the the two patient groups (p O 0.05). 51 patients (F522, M529) age 45.8 (610.2) years reported positive results and avoided surgery fol- lowing SNRI while 40 patients (F516, M524) age 43.1 (612.0) years proceeded to surgery within 189 (6125) days post injection. 15 patients received multiple injections, and of these, 9 did not require surgical inter- vention. Age, gender, and level/side of pathology did not influence the treatment outcome (p O0.05) while injecting physician and injectate ap- peared to influence outcome, though not significantly. Worker’s Compen- sation status influenced outcome significantly (p ! 0.05). These patients demonstrated less benefit from SNRI, requiring a significantly greater need for surgical treatment. CONCLUSIONS: SNRIs are an important treatment tool, preventing the need for surgery in 56% of patients suffering with LDH and easing the surgical burden on a taxed health care system. FDA DEVICE/DRUG STATUS: Kenalog: Approved for this indication; Marcaine: Approved for this indication; Triamcinalone: Approved for this indication. doi: 10.1016/j.spinee.2009.08.038 30. What is the Rate of Occurence of New Fractures at Levels Adjacent to Index Fractures in Osteoporotic Nonagenarians after Percutaneous Vertebroplasty Michael Depalma, MD 1 , Jessica Ketchum, PhD 2 , Evan Queler, MD 3 , Bruce Frankel, MD 4 , Michael Frey, MD 5 ; 1 VCU Spine Center, Columbus, OH, USA; 2 VCU Spine Center, Richmond, VA, USA; 3 Virginia Commonwealth University, Richmond, VA, USA; 4 Medical University of South Carolina, Charleston, SC, USA; 5 Fort Myers, FL, USA BACKGROUND CONTEXT: Vertebral compression fractures (VCF) can cause lumbar pain and disability in osteoporotic patients and have been asso- ciated with significant morbidity and mortality. Percutaneous vertebroplasty (PV) is a percutaneous treatment for VCF patients involving the direct injec- tion of polymethylmethacrylate (PMMA) into the fractured vertebrae. Occurrence of subsequent adjacent level fracture after vertebroplasty has been observed to occur with a rate between 0-16%. The relative risk of frac- ture of vertebrae adjacent to augmented levels is greater than that associated with fracture of distant fractures and adjacent level fractures occur more quickly than distant fractures. These findings suggest an iatrogenic causality of these adjacent level fractures related to the augmentation procedure rather than the underlying metabolic bone disease leading to reduced bone mineral density. PURPOSE: To identify whether fracture of vertebrae adjacent to an initial fractured level occur more commonly after percutaneous vertebroplasty of the index fracture than index fractures not treated with vertebroplasty. STUDY DESIGN/SETTING: A prospective observational cohort study. PATIENT SAMPLE: Consecutive 90-99 year-old, osteoporotic patients presenting with symptomatic thoracic, thoracolumbar, or lumbosacral VCF’s. OUTCOME MEASURES: Occurrence of new fractures involving vertebrae adjacent to initially treated VCF’s. METHODS: Baseline pain and disability was recorded. Each procedure was performed under light intravenous conscious sedation under fluoroscopic guidance. Two to three ml’s of PMMA were injected via a bipedicular ap- proach into each fractured vertebral body. Patients were followed for a period of 24 months and assessed for onset of new symptomatic VCF’s. The rate of new adjacent fractures was then compared to rates reported in the Fracture Intervention Trial which observed adjacent level fractures in 10.5% of non-vertebroplasty patients not being treated pharmacologically for osteopo- rosis and 3.4% in non-vertebroplasty patients treated with alendronate. RESULTS: 122 patients, 91 females, with a mean age5 94.8 years, with mean symptom duration of 35.7 days underwent PV for 163 VCF’s. All patients were available at each follow up interval except 3 patient who died due to unrelated pulmonary disease between the 12 and 52 week follow up. No complications were encountered at any follow up interval. Thirteen pa- tients (10.7%) suffered 16 (13.1%) new fractures at a mean of 20.8 weeks (1-52 weeks) after vertebroplasty with 6 new fractures (4.9%) involving an adjacent level in 5 patients (4.1%). Comparisons of adjacent fractures be- tween groups were analyzed using chi-square analysis. CONCLUSIONS: Occurrence of adjacent fractures after percutaneous ver- tebroplasty (4.9%) is less than adjacent level fractures in patients after an in- dex fracture not treated with vertebroplasty or osteoporotic medications (10.5%) (p-value 5 0.0356). However, the occurrence of new adjacent level fractures after vertebroplasty in the nongenarians was not equivalent to the adjacent level fracture rate in patients treated with bisphosponate when con- sidering an equivalence limit reflecting at least 80% of the effect observed in the FIT trial (3.4% versus 10.5%). FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2009.08.039 16S Proceedings of the NASS 24th Annual Meeting / The Spine Journal 9 (2009) 1S-205S