RESULTS: Mean sessions before discharge were 3562 (mean attendance 921%.). PDL increased significantly from 1.6560.12 at program start to 3.5160.16 at completion (p ! .05). PDL as determined by FCA was signif- icantly greater than approximated by floor-to-waist lifting (4.1661.15 vs. 3.5160.16 respectively; p !.05). PDL as approximated by floor-to-waist lift changed significantly between weeks 1–2, 2–3, 3–4, 4–5, 5–7, 6–8, 7–10 (p !.05 for each pair). There were no significant differences between Week 8 and any later time point thru Week 12. CONCLUSIONS: These results demonstrate that functional improve- ments occur rapid (weekly) in the early phase of SPWC/H as evidenced by the significant weekly differences thru Week 5. Additional functional improvements occurred at a decreased rate (every two weeks) thru Week 8. A small but significant increase occurred between Week 7 and 10. Cor- recting for the difference between floor-to-waist approximated and FCA measured PDL, the difference in PDL between weeks 4 (MEDIUM), 8 (MEDIUM-HEAVY), and 10 (MEDIUM-HEAVY) suggests that maxi- mum medical improvement was typically reached during the 8th week of rehabilitation. These results provide an evidence based mechanism to identify maximum medical improvement in patients enrolled in SPWC/H. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.370 P160. Tuberculosis Spine: Management Strategies in a Developing Country Dwarakanath Srinivas 1 , Venkataramana Neelamkrishna 1 , Swaroop Gopal 2 , Satish Rangappa 3 ; 1 Manipal Hospital, Bangalore, India; 2 Manipal Institute for Neurological Disorders, Manipal Hospital, Bangalore, Bangalore, India; 3 Manipal Institute for Neurological Disorders, Bangalore, India BACKGROUND CONTEXT: Tuberculosis is one of the most common infectious diseases in India especially in the lower socioeconomic strata. Spinal tuberculosis is a major cause of morbidity and can have devastating neurological sequelae if improperly managed. PURPOSE: In this retrospective study we review the various presentations and surgical management strategies in spinal tuberculosis. We also review the data on the patients with multi-drug-resistant (MDR) tuberculosis. STUDY DESIGN/SETTING: This retrospective study included all pa- tients who were operated for spinal tuberculosis at our institute between 1994 and 2005. The data on all these patients were analyzed from the inpatient files. PATIENT SAMPLE: Ninety-eight cases of spinal tuberculosis were oper- ated between 1994 and 2004 at our institute. The important surgical issues were relief of compressive myelopathy, reduction or prevention of instabil- ity, and histopathological diagnosis of the lesions. OUTCOME MEASURES: The outcome measure was the clinical re- sponse to therapy. METHODS: The follow-up was collected from the outpatient files. The antitubercular drugs used, and duration of therapy with special reference to multidrug resistance was analyzed. A complete neurological evaluation was performed at every OPD visist to assess the response. A follow-up ra- diological evaluation with X-rays and MRI (where indicated) was per- formed at the end of drug therapy or if patient deteriorated on treatment. RESULTS: The commonest age group of presentation was between the second and third decade. Pain (92%), progressive myelopathy (80%), blad- der disturbance (28%), and skeletal deformities (16%) were the common modes of presentation. Radiological evaluation revealed that the thoracic spine was the most common site of infection. 22% of the patients had in- stability and required instrumentation. Cold abscess was seen in 28% of patients. The surgical approach (anterior, lateral, or posterior) was based on the location of the lesion. The neurological outcome depended on the preexisting motor deficits and the location of the lesion. Lumbar tuberculosis had good outcome, whereas dorsal tuberculosis had a rela- tively higher morbidity followed by cervical tuberculosis. 19% of these pa- tients had drug resistance and needed second-line drug therapy. Two patients who underwent instrumentation needed implant revision due to progression of disease. Both the patients had MDR TB. CONCLUSIONS: Aggressive surgical management along with antituber- cular drug therapy is necessary for optimal management and preventing further deterioration. Instrumentation when indicated allows early ambula- tion and prevents spinal deformities. MDR tuberculosis needs to be recog- nized early and managed with second-line ATT for good results. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/j.spinee.2006.06.371 P161. A Novel, Minimally Invasive Access Technique for Stand- Alone Lumbar Interbody Fusion in Spondylolisthesis: Preliminary 13-Month Results on the Deployable Optimesh Graft Device Sandi Lam, MD 1 , Giancarlo Guizzardi, MD 2 , Ricardo Morichi, MD 2 , Alessandro Vagaggini, MD 2 , Larry Khoo, MD 3 ; 1 University of California, Los Angeles, Los Angeles, CA, USA; 2 Careggi Hospital, Florence, Tuscany, Italy; 3 Los Angeles, CA, USA BACKGROUND CONTEXT: Optimesh (Spineology, Stillwater, Minne- sota) is a novel deployable interbody device used here for lumbar inter- body fusion in spondylolisthesis by a minimally invasive access technique. It is inserted through a fixed 8-mm cannula, expands in situ when filled with allograft, and minimizes the degree of extensive facet re- moval and neural retraction typically required for exchange of working tools and insertion of fixed cages in posterior interbody procedures. PURPOSE: This study characterizes the preliminary experience with Optimesh for in situ interbody fusion for lumbar spondylolisthesis. STUDY DESIGN/SETTING: This is a retrospective case series of 18 pa- tients with adult spondylolisthesis who underwent lumbar fusion with the Optimesh system. PATIENT SAMPLE: n518. OUTCOME MEASURES: Data were collected through personal inter- view, clinical examination, radiographic analysis, and medical record re- view. Radiographic parameters, Visual Analog Scale for pain pre- and postoperatively, time for return to activity, length of hospital stay, length of surgical time, and estimated blood loss were recorded. METHODS: 18 patients from 33 to 76 years of age (average 58 years), 10 female and 8 male, with spondylolisthesis at L3-4, L4-5, or L5-S1 were treated with minimally invasive decompression and interbody fusion with Optimesh. Postoperative follow-up ranged from 8 to 24 months (average 13 months). RESULTS: Operative times ranged from 110 to 240 minutes (mean 177 minutes). Blood loss was uniformly less than 100 cc. There were no dur- otomies, neural injuries, transient or permanent paresthesias, or blood transfusions. Two superficial wound infections resolved with antibiotic therapy, and irrigation and debridement without removal of instrumenta- tion. Clinical follow-up revealed a preoperative Visual Analog Scale mean of 8.7, VAS mean of 2.7 one week after surgery, and return to activity in a mean of 49 days (range 10 to 240 days). Radiographic follow-up with X- ray, CT, and MRI showed the Optimesh engaged between vertebral body end plates in a lock-and-key type configuration, no increase in spondylolis- thesis, and no instability on lumbar flexion/extension X-rays at 3 to 12 months. CONCLUSIONS: Preliminary 13-month results of the Optimesh system used in lumbar interbody fusion for spondylolisthesis demonstrate it to be a viable interbody fusion device with minimal risk for intraoperative complications characteristically associated with fixed-sized grafts and cages. 160S Proceedings of the NASS 21st Annual Meeting / The Spine Journal 6 (2006) 1S–161S