30. What is the Responsiveness of Clinical Insomnia to Interdisciplinary Functional Restoration in Chronic Disabling Occupational Spinal Disorders? Tom G. Mayer, MD 1 , Sali R. Asih, PhD 2 , Randy Neblett, MA, LPC, BCB 1 , Robert J. Gatchel, PhD 3 ; 1 PRIDE Research Foundation, Dallas, TX, US; 2 Arlington, TX, US; 3 University of Texas Department of Psychology, Arlington, TX, US BACKGROUND CONTEXT: Insomnia is commonly reported by chronic spinal pain patients. In a study presented at last year’s NASS An- nual Meeting, 99% of a chronic disabling occupational spinal disorder (CDOSD) cohort reported some level of insomnia, and 73% reported mod- erate to severe symptoms. Insomnia was found to be statistically indepen- dent of self-reported pain and depression, dispelling the belief that insomnia is simply a secondary symptom of pain and/or depression. PURPOSE: To examine the responsiveness of insomnia in a CDOSD co- hort to interdisciplinary functional restoration (FR) and to evaluate the re- lationship between post-treatment insomnia, pain, depressive symptoms, medication and objective work outcomes. STUDY DESIGN/SETTING: A prospective cohort study. PATIENT SAMPLE: A consecutive sample of 222 patients who completed a FR program at a regional referral center between 2010 and 2011. OUTCOME MEASURES: Insomnia was assessed with the Insomnia Severity Index (ISI), a patient-report measure of insomnia symptoms, upon admission and discharge from the FR program. Three groups were formed, based on the admission ISI total scores: Clinical Insomnia (CI5moderate to severe symptoms, score 15-28); Sub-threshold Insomnia (STI5minimal to mild symptoms, score 1-14); and no insomnia symp- toms (NI, score 0). The Pain Intensity Visual Analog Scale (PVAS) and the Beck Depression Inventory (BDI) were also administered. In addition, the relationship between insomnia symptoms and the use of sedatives and opioids was assessed. Work status outcomes were collected one year post- program. METHODS: Repeated measures ANOVAs and chi-square tests evaluated differences in psychosocial measures, medication use, and 1-year work outcomes. RESULTS: The mean ISI scores significantly improved (p ! .01) from pretreatment (M517.5, SD56.5) to post-treatment (M512.8, SD57.2). Also, 35% of patients moved to a less severe level of insomnia. Despite these improvements, 55% of patients continued to report CI post-treatment, much less improvement than seen for depression or pain. Compared to STI pa- tients, CI patients were more likely to report severe pain (OR52.8; p !.01), severe depressive symptoms (OR56.2; p ! .01), and to use sedatives (OR52.9; p !.01) or opioids (OR52.8; p !.01) post-treatment. No NI pa- tients were using opioids post-treatment. Among patients who had returned to work post-treatment, 85-91% in the NI and STI groups had retained work 1 year after FR completion, compared to 67% in the CI group (OR52.8; p5.024). CONCLUSIONS: Patient-reported insomnia improved in only a minority of CDOSD patients, while a significant majority continued to report mod- erate to severe CI following FR treatment. Those who retained CI showed significantly more pain, depression, sedatives and opioid use. Those whose insomnia resolved completely had no post-FR use of opioids whatsoever. Post-treatment CI clearly predicted much worse work retention 1 year later, at a rate approximately 20% lower than NI and STI patients. Al- though this cohort study cannot prove causation, continued distress and un- certainty about the future, and continued use of opioids (known to disrupt normal sleep patterns) may explain the high percentage of CI at program discharge. Recognizing that CI can occur independently of pain and de- pression, the administration of more rigorous medical and behavioral inter- ventions for insomnia during and after FR may improve vital work and patient-reported outcomes. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.065 31. Multicenter Randomized Controlled Trial Comparing Particulate Versus Nonparticulate Corticosteroids via Lumbar Transforaminal Epidural Injection for Acute Unilateral, Unilevel Radicular Pain Due to Herniated Nucleus Pulposus D.J. Kennedy, MD 1 , Ellen K. Casey, MD 2 , Joshua D. Rittenberg, MD 3 , Paul H. Lento, MD 4 , Matthew Smuck, MD 5 ; 1 Redwood City, CA, US; 2 Chicago, IL, US; 3 Kaiser Permanente Department of PM&R, Oakland, CA, US; 4 Lakewood Ranch, FL, US; 5 Menlo Park, CA, US BACKGROUND CONTEXT: Epidural injections for radicular pain due to an acute herniated nucleus pulposus can be done with either particulate corticosteroids or nonparticulate steroids. Particulate steroids have been routinely utilized, but they have the known complication of paralysis if in- jected intra-arterially due to an embolic effect. Nonparticulate corticoste- roids do not have this complication but their efficacy has been questioned. PURPOSE: To compare the efficacy of particulate (triamcinolone 60 mg) versus nonparticulate (dexamethasone 15 mg) corticosteroids for acute unilateral, unilevel radicular pain due to a herniated nucleus pulposus. STUDY DESIGN/SETTING: Multicenter, randomized, double blind controlled trial. PATIENT SAMPLE: 103 subjects were enrolled and randomized. OUTCOME MEASURES: The primary outcome measures were the need for surgery and number of injections received. Secondary outcome mea- sures were categorical percentage of subjects having 50% pain reduction and Oswestry Disability Index at 2 weeks, 3 months and 6 months. METHODS: Subjects with ! 6 months of unilateral, unilevel lancinating radicular pain due to herniated nucleus pulposus demonstrated on MRI were randomized to receive either 60 mg triamcinolone or 15 mg dexa- methasone via lumbar transforaminal epidural injection by an independent physician. The subjects were blinded as was the treating physician. Sub- jects were followed at 2 weeks, 3 months, and 6 months. RESULTS: There were no statistical significant differences between the groups, but some trends did emerge. At 6 months, 13.7% of the dexameth- asone group and 17.9% of the triamcinolone group required surgery. The average number of injections received was 1.4 for the triamcinolone group and 1.6 for the dexamethasone group. The dexamethasone group had 82.8% of subjects receive 50% pain reduction at 6 months, and the triam- cinolone group had 93.8% with 50% reduction in pain at 6 months. CONCLUSIONS: There were no statistically significant differences in ef- ficacy of particulate and nonparticulate corticosteroids for acute radicular pain due to a herniated nucleus pulposus. FDA DEVICE/DRUG STATUS: Triamcinolone (Not approved for this indication), Dexamethasone (Not approved for this indication) http://dx.doi.org/10.1016/j.spinee.2013.07.066 32. When Is it Safe to Return to Driving After Cervical and Lumbar Spinal Surgery? Trevor Scott, MD 1 , William C. Pannell, BS 2 , David D. Savin 3 , Stephanie S. Ngo 4 , Kristin A. Toy, BS 5 , Michael D. Daubs, MD 6 , Daniel C. Lu, MD, PhD 7 , Jeffrey C. Wang, MD 5 ; 1 University of California Los Angeles Department of Orthopedic Surgery, Santa Monica, CA, US; 2 El Dorado Hills, CA, US; 3 Chicago, IL, US; 4 Los Angeles, CA, US; 5 University of California Los Angeles School of Medicine, Los Angeles, CA, US; 6 Santa Monica, CA, US; 7 Rancho Palos Verdes, CA, US BACKGROUND CONTEXT: Surgeon’s recommendations for safe re- turn to driving following cervical and lumbar surgery are often based on empirical data. Driver reaction time (DRT) is an objective measure for test- ing ability to drive safely. Data about the effect of cervical and lumbar sur- gery on DRT are limited. PURPOSE: The purpose of our study was to use DRT to determine when patients undergoing cervical and lumbar surgery may safely return to driving. STUDY DESIGN/SETTING: This was a prospective study. PATIENT SAMPLE: 37 patients were prospectively tested and followed. 15S Proceedings of the NASS 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.