PM&R Vol. 6, Iss. 9S, 2014 S331

Poster 415Reduction of UTI Incidence and Bacteriuria in SCIPatient Using Standardized 36mg PAC CranberryExtract Supplement.Matthew Sand, MD (Shepherd Center, Atlanta, GA,United States); Chrissy Warren, MS.

Disclosures: M. Sand, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: Adult female patient with spinal cord injurythat utilizes clean intermittent catheterization (CIC). Patient hada history of recurrent UTIs. Patient was initially administered one100mg capsule B.I.D. of nitrofurantoin for 7 days, along witha once daily dose of 36mg Proanthocyanidins (PAC) in the form ofa standardized cranberry extract. Once the antibiotic therapy wasconcluded, the patient continued to take the once daily dose of36mg Proanthocyanidins (PAC) for 6 months.Setting: Rehabilitation Hospital.Results or Clinical Course: At 3 months and 6 months,a urinalysis was performed. There was a significant reduction inasymptomatic bacteriuria, as well as reduced incidence of acuteurinary tract infections.Discussion: Recurrent urinary tract infections (UTIs) are a frus-trating problem that plagues SCI patients and poses a challenge topractitioners. This UTI management method provides a cost-effective approach to prevention of infection and reduction inantibiotic utilization thus reducing antibiotic resistance.Conclusions: Reduction of UTI incidence and bacteriuria levelsamong SCI patients who self-catheterize can be achieved usinga standardized 36mg PAC cranberry extract supplement.

Poster 416Partial Preservation of Sacral Sensation and LowerMotor Neuron Function in a Patient with Rhizotomy ofSacral Nerve Roots: A Case Report.Jeffrey LaVallee, MD (University of Virginia, Charlottes-ville, VA, United States); Geoffrey Smith, MD.

Disclosures: J. LaVallee, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: A 64-year-old woman with a large sacro-coccygeal chordoma.Setting: Inpatient rehabilitation hospital.Results or Clinical Course: The patient initially presentedwith a one-year history of lower back pain. Imaging revealed a large(9.8 cm � 3 cm � 8 cm) infiltrative sacral mass extending into thespinal canal, which was biopsied and diagnosed as a sacrococcygealchordoma. She subsequently underwent surgical resection of thechordoma, which included partial sacrumectomy, decompressiveL5-S3 laminectomy, and rhizotomy of the right S2 and bilateralS3-S5 nerve roots. Postoperative physical examination revealed atleast partial preservation of sensation to light touch and pin prick inall of the sacral dermatomes with the exception of the right-sidedS3-S4 dermatome. The bulbocavernosis and anocutaneous reflexeswere partially preserved and there was a weak volitional analcontraction present. Given the partial preservation of sacral reflexesthe patient was started on a bowel program consisting of dailysuppository with manual disimpaction as needed. This programwas continued throughout her inpatient rehabilitation course

with moderate success at maintaining bowel continence and wascontinued post discharge.Discussion: The finding of partially preserved lower sacralsensation and reflexes on physical examination is inconsistent withthe operative report stating that the right S2 and bilateral S3-S5nerve roots were sacrificed. In theory, this patient should havepresented with saddle anesthesia and areflexic pelvic floor.However, this was not the case with this patient, and the bowelprogram was adjusted accordingly. Possible explanations includean aberrant neuroanatomical variation of the lumbosacral plexuswith pathways above S2 innervating structures typically innervatedby the lower sacral nerve roots. It is unclear if the chordoma, whichis thought to arise from ectopic notochord remnants, is associatedwith this aberrant anatomy or if this is coincidental.Conclusions: Neuroanatomical variations of the lumbosacralplexus may cause unexpected clinical outcomes.

Poster 417An Unusual Case of Bilateral C5 Palsy After CervicalFusion.Melissa Xenidis, DO (Marianjoy Rehabilitation Hospital,Wheaton, IL, United States); Dennis Keane, MD.

Disclosures: M. Xenidis, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: A 76-year-old man with a history ofmechanical fall and resultant neck pain, but normal neurologicalexamination, was found with severe cervical stenosis from C3-4 toC6-7 on cervical MRI investigation. He underwent C3-T1 lam-inectomy and fusion, in which immediately post-op he was notedto have 0/5 strength in the bilateral C5 myotomes (shoulderabduction and elbow flexion) as well as diminished pin pricksensation in the bilateral C5 dermatomes. Re-imaging of the cervicalspine showed only post-op findings and no signs of spinal cord ornerve root impingement.Setting: Acute Inpatient Rehabilitation Hospital.Results or Clinical Course: Neurologic symptoms persistedthrough his 3 week acute inpatient rehabilitation stay and upondischarge he was modified independent for transfers and gait, whilerequiring minimal assistance for his ADLs.Discussion: Unilateral C5 palsy is not an uncommon compli-cation after cervical laminectomy and fusion surgeries with therate reaching as high as 10.6%. Symptoms can include paralysisof the deltoid and/or bicep brachii, with possible sensory deficitsand/or intractable pain in the corresponding dermatome.Though no direct causality can be linked with incidences, thereare some anatomical considerations hypothesized. The rootletand root of C5 are shorter than in other segments and may bemore prone to tethering during vertebral body shifting. C5 isusually the apex of cervical lordosis and the midpoint of de-compression, which could place greater shifting movementat this segment. While 70% of affected patients show completerecovery from paralysis within 7.9 months, 30% remain withresidual motor paralysis.Conclusions: Physicians and patients need to be aware of thepotential risk of C5 palsy after cervical fusion surgery. Affectedpatients need to have adequate therapies, education, appropriateadaptive equipment to maximize functional independence, andmuch encouragement as with time the majority of affected patientswill have full recovery.