PURPOSE: The hypothesis of this subgroup analysis was that asymmetric motor weakness would be associated with significantly less improvement in outcome compared to patients who did not have any neurological deficit. STUDY DESIGN/SETTING: Randomized controlled trial. PATIENT SAMPLE: 1191 patients. OUTCOME MEASURES: Short Form-36 (SF36), Oswestry Disability Index (ODI), Sciatica Bothersomeness Index. METHODS: The study population includes patients enrolled in SPORT for treatment of IDH. Patients were divided according to whether or not they had asymmetric motor weakness (AMW) at baseline. Change in pri- mary outcome measures and treatment effect of surgery were assessed at baseline and final follow-up. RESULTS: There were 501 AMW patients and 690 No-AMW patients. There were significant gender differences between groups in gender, in- come under 50,000, and compensation status. At baseline, there was signif- icantly (p ! .05) worse baseline SF36 BP, ODI, Sciatica Frequency Index, Sciatica Bothersomeness Index, and increased preference for surgery at baseline (AMW 56% vs No-AMW 46%). There was an increased percent- age of sensory deficit and reflex deficit in the AMW patients. There was an increased percentage of extruded disks and an increased percentage of the AMW patients received surgery. There was a decreased rate of reoperation at the AMW patients at 2,3, and 4 years (p ! .001). Averaged over four years, there was no significant difference in the primary or secondary out- come measures or treatment effect of surgery. There was no significant dif- ference in crossover between groups in the AMW patients. CONCLUSIONS: There was no significant difference in outcome of pa- tients with asymmetric motor weakness compared to patients without asymmetric motor weakness. Both surgical and nonsurgical treatment of patients with asymmetric motor weakness resulted in improvement in me- dium term outcome. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.215 163. Does Opioid Pain Medication Use Affect the Outcome of Patients with Lumbar Disc Herniation? A Subgroup Analysis of the SPORT Study Kris Radcliff, MD 1 , Mitchell Freedman, DO 2 , Alan Hilibrand, MD 2 , Wenyan Zhao 3 , Jon D. Lurie, MD 4 , Tor Tosteson, ScD 5 , Jeffrey Rihn, MD 6 , Todd Albert, MD 2 , James Weinstein, DO 7 ; 1 Ben Franklin House, Egg Harbor Township, NJ, USA; 2 Rothman Institute, Philadelphia, PA, USA; 3 Hanover, NH, USA; 4 Dartmouth College, Lebanon, NH, USA; 5 Dartmouth Medical School, Lebanon, NH, USA; 6 Thomas Jefferson University Hospital, The Rothman Institute, Philadelphia, PA, USA; 7 Dartmouth Hitchcock Medical Center, Lebanon, NH, USA BACKGROUND CONTEXT: The SPORT trial is a prospective, multi- center study of surgical treatment versus nonoperative treatment for lum- bar intervertebral disk herniation (IDH). PURPOSE: The hypothesis of this study was that patients who received opoid pain medications during treatment will have improved outcome compared to patients who did not receive opoid medications. STUDY DESIGN/SETTING: Randomized controlled trial. PATIENT SAMPLE: 1244 patients. OUTCOME MEASURES: Short Form-36 (SF36), Oswestry Disability Index (ODI), Sciatica Bothersomeness Index. METHODS: The study population includes patients enrolled in SPORT for treatment of IDH in combined randomized and observational cohorts. Patients who received opoid pain medications at baseline (Opoid) were compared to those who did not (No-Opoid). Outcome measures were as- sessed at baseline, 1 year, 2 years, 3 years, and 4 years. The difference in improvement between surgical and nonoperative treatment (treatment effect) was determined at each follow-period for each group. RESULTS: There were 520 patients in the Non-Opoids group and 542 pa- tients in the Had-Opoids group. At baseline, there was significantly increased (p ! .05) disability, compensation claims, and smoking in the opoid medication patients (542/1244 IDH patients). There was signifi- cantly (p ! .001) worse baseline SF36 BP, SF36 PF, SF36 MCS, SF36 PCS, ODI, Sciatica Frequency Index, Sciatica Bothersomeness Index, Back Pain Bothersomeness Index, and percent dissatisfaction in the opoid medication group. There was an increased percentage of patients in the opoid medication group with the perception of worsening symptoms (p ! .001). There was an increased percentage of any neurological deficit, motor weakness, decreased sensation, and received surgery in the opoid medication group. At four years follow-up, there were no significant differ- ences in primary or secondary outcome measures or treatment effect of surgery between opoid and non-opoid medication patients. There was significantly less crossover to nonsurgical treatment in the opoid patients versus the non-opoid patients (11% vs 19%, p5.0108). There was signif- icantly increased crossover to surgery in the opoid pain medication patients (45% versus 31%, p5.0045). CONCLUSIONS: Patients who were treated with narcotic pain medica- tion had no significant difference in long term outcome following surgery for IDH. The lower functional status and higher pain levels which were seen at baseline in patients who were taking opiates, would seem to justify the use of an increase in medication for pain control. Though patients who were treated with opoid pain medications had significantly worse baseline health status, there was no long term difference in outcome associated with opoid pain medication use. Understandably, patients who required opoid pain medication were more likely to undergo surgical intervention. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2011.08.216 164. Direct Decompression and CoflexÒ Interlaminar Stabilization Compared with Laminectomy and Posterior Spinal Fusion with Pedicle Screw Instrumentation for Spinal Stenosis with Back Pain or Degenerative Spondylolisthesis: Two-Year Results from the Prospective, Randomized, Multicenter FDA IDE Trial Joshua Auerbach, MD 1 , Reginald Davis, MD, FACS 2 , Thomas Errico, MD 3 , Hyun Bae, MD 4 ; 1 Brooklyn, NY, USA; 2 Greater Baltimore Neurosurgical Assoc., Baltimore, MD, USA; 3 New York University Medical Center, NewYork, NY, USA; 4 Spine Institute St. John’s Health Center, Los Angeles, CA, USA BACKGROUND CONTEXT: Laminectomy and posterior spinal fusion are commonly performed for patients with degenerative spondylolisthesis and spinal stenosis with significant low back pain. Long-term untoward se- quelae of lumbar fusion have led to the search for motion-preserving, less- invasive alternatives. PURPOSE: To evaluate the safety and efficacy of the coflexÒ interlami- nar device compared to posterior spinal fusion in the treatment of 1- and 2- level spinal stenosis and degenerative spondylolisthesis. STUDY DESIGN/SETTING: Prospective, randomized, multicenter FDA IDE trial comparing direct decompression and coflexÒ interlaminar stabi- lization with laminectomy and posterior spinal fusion. PATIENT SAMPLE: 219 patients (146 coflexÒ and 73 fusion controls) were randomized and treated from 21 sites in the United States to receive di- rect decompression and coflexÒ interlaminar stabilization or laminectomy and posterolateral spinal fusion with spinal instrumentation in a 2:1 ratio. OUTCOME MEASURES: Perioperative data, ODI, VAS Back, VAS (worse) Leg, SF-12, ZCQ, and radiographic outcomes at minimum 2 years. Overall device success was a composite of O15-point reduction in ODI, no reoperations, no major device-related complications, and no post-operative epidural injections. METHODS: Study inclusion consisted of moderate spinal stenosis with significant low back pain (VAS Back Pain $50/100) and significant dis- ability (ODI$40%), with up to Grade I spondylolisthesis, at spinal seg- ments from L1-L5. Data were collected preoperatively, then at 6 week, 3 month, 6 month, 12 month, 18 month, and 24 month time points. 86S Proceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.