PM&R Vol. 6, Iss. 9S, 2014 S375

misuse and co-occurring psychiatric disorders in chronic painpatients.Design: Retrospective randomized study.Setting: Clinic setting.Participants: 1,629 chronic pain patients (817 female and812 male) randomly selected at a pain management practice inPhoenix, Arizona.Interventions: The following single nucleotide polymorphisms(SNPs) were evaluated: Serotonin 2a Receptor (5-HT2a 1438G/A), Serotonin Transporter (SLC6A4), Catechol-O-Methyl-transferase (COMT Val108/158Met), Dopamine D2 Receptor(DRD2 A2/A1, A1/A1), Dopamine D1 Receptor (DRD1 -48A/G),Dopamine D4 Receptor (DRD4 -521C/T), Dopamine Trans-porter (SLC6A3 UTR3 C/T), Dopamine Beta Hydroxylase (DBH-1021 C/T), Methylene Tetrahydrofolate Reductase (MTFHRC677T), Human Kappa Opioid Receptor (OPRK1 36G>T),Gamma-Aminobutyric Acid (GABA) (1519T>C GABA(A) alpha6 gene), and Human Mu Opioid Receptor (OPRM1 A118G) tosee if there is any association between any of the SNPs andgender.Main Outcome Measures: Whether an association would befound between males or females and the homozygous mutant of theSNPs, to see if there is any difference between males and femalesand their DRI scores (Opioid dependent Risk Index, a tool formeasuring risk of prescription opioid addiction 12-36).Results or Clinical Course: In the chi-square association test,only OPRM showed a statistical significant association with genderbut this was not supported by further analysis. There was nostatistically significant difference in the prevalence of homozygousmutants when compared against the Normal in all twelve SNPsbetween male and female subjects (p>0.05). There was also nostatistically significant difference in the average Narcotic Risk Indexscore between male and female subjects (average 18.56 for malesand 18.44 for females, respectively). The Independent sampleT-Test result was (Males Group 1 and Females Group 2, F¼ .157,P¼ .692, T¼ -1.137, DF (1627) P¼.256 Mean difference.-126)showing no significant difference for DRI scores for either males orfemalesConclusions: This observational study suggests that there is nodifference in prevalence of homozygous mutations in these SNPsbetween male and female subjects.

Poster 539Foix Alajouanine Syndrome: A Rare Cause of BackPain and Bilateral Lower Extremity Weakness. A CaseReport.Sonia Goel, MD (Montefiore Medical center, Bronx, NY,United States); Hejab Imteyaz, MD; Steven A. Sparr, MD.

Disclosures: S. Goel, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: We report a case of a 49-year-old man withchronic low back pain who presented with a rapidly progressivemyelopathy.Setting: Tertiary care hospital.Results or Clinical Course: The patient developedlumbar radiculopathy 2 years prior to admission and wastreated epidural injections and physical therapy with someimprovement. He was admitted for progressive bilateral lower

extremity weakness for 1 month associated with gait distur-bance, sensory loss in the lower limbs and fecal and urinaryincontinence. EMG showed multilevel lumbar radiculopathies.Lumbar and thoracic spine MRI revealed expansion of the cordand abnormal gadolinium enhancement extending from T9 tothe conus associated with dilated intrathecal and intercostalveins, suspicious for an underlying spinal dural aterial-venousfistula with associated venous congestion resulting in spinalcord ischemia. Spinal angiogram confirmed the vascular mal-formation and he received Onyx embolization. Following theprocedure the patient reported decreased pain and withsubsequent outpatient physical therapy, showed improvementin strength in the lower limbs and improvement in gait.Discussion: In 1926 Foix and Alajounanine described a subacutemyelopathy produced by a thrombotic process of the spinal cordthat ultimately caused death of the patient. In 1931 Lhermitte andcolleagues recognized this process as caused by a spinal arteriove-nous malformation with a rapidly progressive myelopathy resultingfrom thrombosis of the abnormal vessels within spinal cord. Priorto the development of catheter embolization techniques Foix Ala-jouanine Syndrome was felt to be irreversible and to carry a poorprognosis.Conclusions: Foix Alajouanine syndrome is a rare cause oflumbar radicular pain with evolution to a rapidly progressivemyelopathy. In most patients sensory symptoms, pain and legweakness are the initial symptoms. This syndrome should beconsidered in patients with lumbar radiculopathy who progress todevelop myelopathic symptoms.

Poster 540Extensive Lumbar Paraspinal Denervation followingRadiofrequency Ablation.Seth D. Scholl, DO (Coastal Spine, Mount Laurel, NJ,United States).

Disclosures: S. D. Scholl, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: The patient presented to the office withright-sided low back pain. Radiological workup was negative forobvious findings and medial branch blocks gave 100 percenttemporary relief. The patient then underwent radiofrequencyablation to the right L4-5 and L5-S1 facet joints. At his 3-weekfollow up visit he stated that his original pain was gone, but nowhad a different pain in the similar area. After treating this newdiscomfort with watchful waiting and medications withoutimprovement, a new MRI was ordered. He was found to haveextensive denervation of the lumbar paraspinals in the region ofablation.Program Description: Office Based Practice.Setting: Office Based Practice.Results or Clinical Course: A new MRI with and withoutcontrast was performed to rule out an infection. Blood work wasordered and this was normal. In reviewing the literature, it iscommon to see denervation of multifidus following radiofrequencyablation, but not the entire Lumbar paraspinal group.Conclusions: I found no case studies demonstrating suchextensive denervation following a radio frequency procedure. Itshould be included in the differential of someone with chronic painfollowing this procedure.