Rare Complications of Cervical Spine Surgery: Pseudomeningocoele.

STUDY DESIGN: This study was a retrospective, multicenter cohort study. OBJECTIVES: Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience. METHODS: This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and experienced a postoperative PMC. RESULTS: Thirteen patients (0.08%) developed a postoperative PMC, 6 (46.2%) of whom were female. They had an average age of 48.2 years and stayed in hospital a mean of 11.2 days. Three patients were current smokers, 3 previous smokers, 5 had never smoked, and 2 had unknown smoking status. The majority, 10 (76.9%), were associated with posterior surgery, whereas 3 (23.1%) occurred after an anterior procedure. Myelopathy was the most common indication for operations that were complicated by PMC (46%). Seven patients (53%) required a surgical procedure to address the PMC, whereas the remaining 6 were treated conservatively. All PMCs ultimately resolved or were successfully treated with no residual effects. CONCLUSIONS: PMC is a rare complication of cervical surgery with an incidence of less than 0.1%. They prolong hospital stay. PMCs occurred more frequently in association with posterior approaches. Approximately half of PMCs required surgery and all ultimately resolved without residual neurologic or other long-term effects.

Epidural Hematoma Following Cervical Spine Surgery.

STUDY DESIGN: A multicentered retrospective case series. OBJECTIVE: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. METHODS: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. RESULTS: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. CONCLUSION: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.

Intraoperative Death During Cervical Spinal Surgery: A Retrospective Multicenter Study.

STUDY DESIGN: A retrospective multicenter study. OBJECTIVE: Routine cervical spine surgeries are typically associated with low complication rates, but serious complications can occur. Intraoperative death is a very rare complication and there is no literature on its incidence. The purpose of this study was to determine the intraoperative mortality rates and associated risk factors in patients undergoing cervical spine surgery. METHODS: Twenty-one surgical centers from the AOSpine North America Clinical Research Network participated in the study. Medical records of patients who received cervical spine surgery from January 1, 2005, to December 31, 2011, were reviewed to identify occurrence of intraoperative death. RESULTS: A total of 258 patients across 21 centers met the inclusion criteria. Most of the surgeries were done using the anterior approach (53.9%), followed by posterior (39.1%) and circumferential (7%). Average patient age was 57.1 ± 13.2 years, and there were more male patients (54.7% male and 45.3% female). There was no case of intraoperative death. CONCLUSIONS: Death during cervical spine surgery is a very rare complication. In our multicenter study, there was a 0% mortality rate. Using an adequate surgical approach for patient diagnosis and comorbidities may be the reason how the occurrence of this catastrophic adverse event was prevented in our patient population.

C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases.

STUDY DESIGN: A multicenter, retrospective review of C5 palsy after cervical spine surgery. OBJECTIVE: Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery. METHODS: We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. P values were calculated using 2-sample t test for continuous variables and χ2 tests or Fisher exact tests for categorical variables. RESULTS: Of the 13 946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%). CONCLUSION: C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date.

Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery.

STUDY DESIGN: Retrospective cohort study of prospectively collected data. OBJECTIVE: To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery. METHODS: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of iatrogenic spinal cord injury. RESULTS: In total, 3 cases of iatrogenic spinal cord injury following cervical spine surgery were identified. Institutional incidence rates ranged from 0.0% to 0.24%. Of the 3 patients with quadriplegia, one underwent anterior-only surgery with 2-level cervical corpectomy, one underwent anterior surgery with corpectomy in addition to posterior surgery, and one underwent posterior decompression and fusion surgery alone. One patient had complete neurologic recovery, one partially recovered, and one did not recover motor function. CONCLUSION: Iatrogenic spinal cord injury following cervical spine surgery is a rare and devastating adverse event. No standard protocol exists that can guarantee prevention of this complication, and there is a lack of consensus regarding evaluation and treatment when it does occur. Emergent imaging with magnetic resonance imaging or computed tomography myelography to evaluate for compressive etiology or malpositioned instrumentation and avoidance of hypotension should be performed in cases of intraoperative and postoperative spinal cord injury.

The risk of radiation exposure to the eyes of the interventional pain physician.

It is widely accepted that the use of medical imaging continues to grow across the globe as does the concern for radiation safety. The danger of lens opacities and cataract formation related to radiation exposure is well documented in the medical literature. However, there continues to be controversy regarding actual dose thresholds of radiation exposure and whether these thresholds are still relevant to cataract formation. Eye safety and the risk involved for the interventional pain physician is not entirely clear. Given the available literature on measured radiation exposure to the interventionist, and the controversy regarding dose thresholds, it is our current recommendation that the interventional pain physician use shielded eyewear. As the breadth of interventional procedures continues to grow, so does the radiation risk to the interventional pain physician. In this paper, we attempt to outline the risk of cataract formation in the scope of practice of an interventional pain physician and describe techniques that may help reduce them.

Evaluation of the patient with neck versus shoulder pain.

Neck and shoulder pain are common complaints among the general population, being the second and third most common musculoskeletal complaints, respectively, after back pain in the primary care setting. Differentiating between neck and shoulder pain can be challenging, as both share symptoms and physical examination findings. The differential diagnoses of neck and shoulder pain are extensive. Providers are encouraged to develop a systematic, comprehensive, and reproducible approach, including thorough history taking and physical examination along with focused diagnostic testing.

Thoracic outlet syndrome.

Of the many clinical entities involving the neck region, one of the most intriguing is thoracic outlet syndrome (TOS). TOS is an array of disorders that involves injury to the neurovascular structures in the cervicobrachial region. A classification system based on etiology, symptoms, clinical presentation, and anatomy is supported by most physicians. The first type of TOS is vascular, involving compression of either the subclavian artery or vein. The second type is true neurogenic TOS, which involves injury to the brachial plexus. Finally, the third and most controversial type is referred to as disputed neurogenic TOS. This article aims to provide the reader some understanding of the pathophysiology, workup, and treatment of this fascinating clinical entity.

Lumbar spondylosis: clinical presentation and treatment approaches.

Low back pain (LBP) affects approximately 60-85% of adults during some point in their lives. Fortunately, for the large majority of individuals, symptoms are mild and transient, with 90% subsiding within 6 weeks. Chronic low back pain, defined as pain symptoms persisting beyond 3 months, affects an estimated 15-45% of the population. For the minority with intractable symptoms, the impact on quality of life and economic implications are considerable. Despite the high prevalence of low back pain within the general population, the diagnostic approach and therapeutic options are diverse and often inconsistent, resulting in rising costs and variability in management throughout the country. In part, this is due to the difficulty establishing a clear etiology for most patients, with known nociceptive pain generators identified throughout the axial spine. Back pain has been termed as "an illness in search of a disease." Indeed, once "red flag" diagnoses such as cancer and fracture have been ruled out, the differential sources of low back pain remain broad, including the extensive realm of degenerative changes within the axial spine for which radiological evaluation is nonspecific and causal relationships are tentative. We will elaborate on these degenerative processes and their clinical implications. We will further discuss diagnostic approaches and the efficacy of existing treatment options.

MRI prediction of therapeutic response to epidural steroid injection in patients with cervical radiculopathy.

OBJECTIVE: To analyze whether magnetic resonance imaging (MRI) findings can be used to predict therapeutic responses to cervical epidural steroid injections (CESI) in patients with cervical radiculopathy. DESIGN: Retrospective single-center study. Patients were categorized by presence or absence of four types of cervical MRI findings (disk herniation, nerve root compromise, neuroforaminal stenosis, and central canal stenosis). Thus, for each of the four types of MRI findings, there was a positive-MRI arm and a negative-MRI arm. Severities of these MRI findings were also noted. The treatment outcome variable was the change in Neck Disability Index (NDI) score after CESI. For each of the four MRI finding types, t test was done to see if there was any significant difference in the outcome between positive-MRI arm and negative-MRI arm. Then, we repeated the same analyses after adjusting the arms to include only those of "major" radiologic severity in the positive-MRI arms. RESULTS: After inclusion and exclusion criteria were applied, 32 patients were included. Only the presence, vs. absence, of central canal stenosis was associated with significantly superior therapeutic response to CESI (mean NDI improvement of 14.14 in positive-MRI arm, vs. mean NDI worsening of 2.11 in negative-MRI arm; P = 0.012). After controlling for other MRI finding types, the statistical significance still held for central canal stenosis (beta = -0.438; P = 0.022). When only the patients with MRI findings of major severities were considered as positive results, central canal stenosis was still the only finding type associated with significantly superior outcome (mean NDI improvement of 23.00 in positive-MRI arm, vs. mean NDI improvement of 0.85 in negative-MRI arm; P = 0.002). Controlling for other MRI finding types, the statistical significance still held for central canal stenosis (beta = -0.534; P = 0.002). CONCLUSIONS: Patients with central canal stenosis achieved significantly better functional outcome after CESI than those without. Hence, the MRI finding of central canal stenosis is a potential indication that CESI may be merited.

Atypical presentation of osteomyelitis, discitis, epidural, and iliopsoas abscess in diffuse idiopathic skeletal hyperostosis (DISH) syndrome.

Spine infections are infrequent but important sources of back pain, posing significant risk of neurological sequelae. Risk factors include diabetes, recent trauma or instrumentation, and infection. Pathogens include Staphylococcus aureus and beta-hemolytic Streptococcus. A 67-yr-old man presented with lower back and hip pain of 2-mo duration without fever. Initial treatment and work-up revealed diffuse idiopathic skeletal hyperostosis. The patient did not improve with conservative care, and neurologic decline was recognized. Magnetic resonance imaging identified osteomyelitis, discitis, and epidural abscesses at the L4-L5 levels. Escherichia coli was identified, and antibiotic treatment with CT-guided drainage precluded the need for surgery. Spine infections and iliopsoas abscesses are conditions that can result in serious disability. Awareness of unusual diagnoses and atypical pain presentations in patients with chronic spine pathology, such as diffuse idiopathic skeletal hyperostosis syndrome, is important to recognize early to minimize neurological sequelae.

Pain precedes computer axial tomography and scintigraphic findings in an osteoporotic vertebral compression fracture: a case report.

OBJECTIVE: To report a case in which pain preceded computer axial tomography (CT) and scintigraphic findings in an osteoporotic vertebral compression fracture. DESIGN/SETTING: Report of a patient presenting to a physical medicine/pain medicine outpatient clinic. PATIENT: Eighty-seven-year-old female with history of osteoporosis and previous vertebral compression fracture with new onset, atraumatic, axial thoracic pain. INTERVENTIONS: Thoracic spine CT, bone scintigraphy, kyphoplasty (Kyphon-Medtronic, Sunnyvale, CA). OUTCOME MEASURES: Not applicable. CASE: History and physical exam were suggestive of thoracic compression fracture. CT and bone scintigraphy were negative for vertebral compression fracture. A CT of the pulmonary arteries during an unrelated hospital admission less than two weeks after initial presentation revealed a compression fracture at T7. Pain report was unchanged except for an increase in intensity. Follow-up X-ray and CT revealed a compression fracture at T7 with loss of 80% of vertebral height. Pain was successfully treated with kyphoplasty. RESULTS: CT and bone scintigraphy performed early after pain onset did not reveal a vertebral compression fracture. Within 2 weeks, fracture was evident on further imaging. The pain resolved following an intervention directed at the fracture. CONCLUSION: The patient's pain preceded CT and scintigraphic evidence of the osteoporotic vertebral compression fracture. It is possible that pain is an early sign of impending osteoporotic compression fracture, or microtrabecular fracture, prior to anatomic and physiologic changes. Magnetic resonance imaging may be the imaging study of choice rather than bone scintigraphy in identification of noncollapsed osteoporotic compression fracture. Earlier identification and treatment of vertebral compression fractures may reduce kyphosis and associated sequelae.

Scapular winging: anatomical review, diagnosis, and treatments.

Scapular winging is a rare debilitating condition that leads to limited functional activity of the upper extremity. It is the result of numerous causes, including traumatic, iatrogenic, and idiopathic processes that most often result in nerve injury and paralysis of either the serratus anterior, trapezius, or rhomboid muscles. Diagnosis is easily made upon visible inspection of the scapula, with serratus anterior paralysis resulting in medial winging of the scapula. This is in contrast to the lateral winging generated by trapezius and rhomboid paralysis. Most cases of serratus anterior paralysis spontaneously resolve within 24 months, while conservative treatment of trapezius paralysis is less effective. A conservative course of treatment is usually followed for rhomboid paralysis. To allow time for spontaneous recovery, a 6-24 month course of conservative treatment is often recommended, after which if there is no recovery, patients become candidates for corrective surgery.

The use of electromyography to predict functional outcome following transforaminal epidural spinal injections for lumbar radiculopathy.

UNLABELLED: This study aimed to determine if electromyographic (EMG) diagnostic evaluation can predict functional outcome in patients undergoing transforaminal lumbar spine epidural injections. In this retrospective study, functional outcome by Oswestry Disability Index (ODI) and verbal rating scale (VRS) for current pain severity was evaluated in 39 patients undergoing lumbar transforaminal epidural spinal injections (ESI). Subjects with low back pain (mean age, 60 +/- 12.5 years) were evaluated for functional improvement post EMG and ESI. Of 39 patients tested with EMG before injection, 18 patients were positive for radiculopathy and 21 had a normal or negative examination. The patients were followed postinjection on average of 10.8 (SD +/- 3.9) weeks. Pretreatment ODI scores were not significantly different between groups showing positive (72.3 SD +/- 12.7) and negative (65.9 SD +/- 18.6, P > .05) EMG findings. There was significantly greater improvement of ODI for EMG positive radiculopathy (7.11 SD +/- 9.5) compared with negative EMG (3.2 SD +/- 17.4, P < .05). Positive radiculopathy subjects complained of more pain by VRS before ESI than subjects with negative EMG findings, 8.1 SD +/- 1.0 and 7.3 SD +/- 0.8, respectively, which was not significant (P > .05). VRS mean improvement was not significantly different in the positive EMG group (1.8 SD +/- 1.2) compared with a negative EMG (1.2 SD +/- 1.2, P > .05). PERSPECTIVE: The results appear to show that patients undergoing transforaminal ESI, who have a positive radiculopathy by EMG before injection, will have significant improvement in functional outcome by ODI but not with current pain intensity by VRS. This study suggests the importance and diagnostic value of ordering electromyography studies for lumbar radiculopathy evaluation, which may lead to prediction of outcome with lumbar transforaminal epidural spinal procedures. Furthermore, the current study highlights the difficulty of pain evaluation outcome by VRS.

The S1 "Scotty dog": report of a technique for S1 transforaminal epidural steroid injection.

OBJECTIVE: To report a technique for needle placement by using the bony landmark of the "Scotty dog" on an oblique view for epidural injection of corticosteroid into the S1 foramina. DESIGN: Brief report on a technique for S1 transforaminal epidural steroid injection. SETTING: Academic multispecialty spine center. PARTICIPANTS: Patients with L5 and S1 foraminal and paracentral disk herniation with concurrent L5-S1 radicular pain. INTERVENTION: Fluoroscopically guided, contrast-enhanced L5 and S1 transforaminal epidural steroid injections (ESIs). MAIN OUTCOME MEASURES: Not applicable. RESULTS: The L5-S1 foramina can be visualized with 1 oblique (and usually caudally tilted) fluoroscopic view. An S1 Scotty dog can be visualized as an anatomic landmark for the guidance of the needle tip into the S1 foramen. While performing simultaneous L5 and S1 transforaminal ESIs, 1 view can be used to guide both needles into the foramen. Thus, the procedure can be completed in less time and potentially with less radiation exposure than if different views for each foramen were to be used. CONCLUSIONS: Classic description of the S1 spinal nerve block uses an anteroposterior approach to the foramen. Looking for an S1 Scotty dog facilitates predictable visualization of the foramen, medial needle placement with epidural flow of contrast, and simultaneous visualization for needle placement to the L5 foramen.

Treatment of iliopsoas tendinitis after a left total hip arthroplasty with botulinum toxin type A.

OBJECTIVE: Treatment of iliopsoas tendinitis after a left total hip arthroplasty with botulinum toxin type A (BTX-A). DESIGN: Case study. SETTING: Outpatient musculoskeletal clinic. PARTICIPANTS: Single patient subject with left iliopsoas tendinitis after a left total hip arthroplasty. INTERVENTIONS: Fluoroscopically guided injection of 100 units of BTX-A into the left iliopsoas muscle. MAIN OUTCOME MEASURES: Functional improvement with Oswestry Disability Index (ODI) and scores using a 0-10 point pain intensity numerical rating scale (PI-NRS) at one and 6 months follow up. RESULTS: A 71-year-old female with 4 months of left groin pain after successful total hip arthroplasty. Work up did not reveal any infection or malpositioning of the left hip prosthetic components. Attempts at aspiration revealed no fluid in the joint space. A positive xylocaine muscle block confirmed a diagnosis of iliopsoas tendinitis. The BTX-A injection resulted in an improved left groin pain rating from a baseline of 7 to 1 and improved ability to flex her left hip at one month follow up. Pain was rated 8 at six months follow up. ODI improved from a baseline of 26% to 22% at one month follow up and 18% at 6 months follow up. CONCLUSIONS: Iliopsoas tendinitis is an uncommon cause of groin pain but has been described after a total hip arthroplasty in several case reports. Non-operative management has not been well established but includes anesthetic and corticosteroid injection into the muscle. The use of botulinum toxin A provided significant pain relief, functional improvement, and may represent an alternative to the surgical management of iliopsoas tendinitis.

Hip migration percentage in children with cerebral palsy treated with botulinum toxin type A.

OBJECTIVE: To determine hip radiographic findings in children with cerebral palsy (CP) treated with botulinum toxin type A (BTX-A). DESIGN: Retrospective chart review with correlation to radiographic findings. SETTING: Academic center. PARTICIPANTS: Sixteen subjects with CP. INTERVENTION: BTX-A treatment to adductor muscles. MAIN OUTCOME MEASURE: The Reimers hip migration percentage before and after BTX-A. RESULTS: Thirty-two hips in 16 children with CP were treated. We examined the effect of initial migration percentage and initial migration percentage age on the change in migration percentage after BTX-A injection. A significant effect for initial migration percentage (<30% or >/=30%; F=19.05, P <.001) and a significant interaction between initial migration percentage and initial migration percentage age (F=7.5, P <.01) was noted. Initial migration percentage age (24 mo) was not significant (F=.95, P =.34). Patients who had an initial migration percentage of 30% or more and were less than 24 months old were more likely to have a decrease in migration percentage after BTX-A injection compared with patients who were older than 24 months and who had an initial migration percentage of 30% or more. CONCLUSIONS: Improvement in hip migration percentage after BTX-A injection is a function of age and the initial migration percentage. BTX-A injections to adductor muscles may be beneficial for some children with CP.

Post-lumbar surgery complex regional pain syndrome.

BACKGROUND: This case report identifies a patient with complex regional pain syndrome Type 2 (causalgia) with sympathetically maintained pain in a distal extremity associated with an anterior sacroiliac fusion with local bone graft. CASE DESCRIPTION: A sacroiliac fusion was undertaken due to chronic back pain that was temporarily relieved with percutaneous injections to the joint space and lower lumber facets. A 65 year-old man underwent a left sacroliac arthrodesis for continued lumbosacral pain. The successful surgery with allograft had no intraoperative complications. The patient remained in the hospital post-operatively for four days with no complications. Four to six weeks post-operative, the patient began to have swelling and pain at the ipsilateral foot. The pain progressed with evidence of allodynia, hyperesthesia, and dystrophic changes in the foot. EMG and a nerve conduction study showed severe denervation that involved not only the muscles below the knee but the quadriceps as well, and also had ongoing irritability of a number of muscles, including those innervated by the femoral, sciatic, and gluteal nerves in the left leg. A diagnosis of complex regional pain syndrome Type 2 (causalgia) was made with the aid of a bone scan. A series of two diagnostic percutaneous chemical sympathectomies were undertaken, and the pain was significantly relieved. This suggested complex regional pain syndrome Type 2 with sympathetically maintained pain. The patient underwent aggressive physical therapy during his rehabilitation and subsequent resolution of the pain syndrome occurred. CONCLUSION: Complex regional pain syndrome Type 2 with sympathetically maintained pain is a condition that can result in serious disability and can be associated with spinal procedures and sacroiliac arthrodesis. Early intervention is recommended to provide long-term resolution of the condition.

Optimal resistance training: comparison of DeLorme with Oxford techniques.

OBJECTIVE: Progressive resistive exercises, such as the DeLorme or Oxford techniques, improve strength by adding weights to arrive at the ten-repetition maximum (10RM; DeLorme) or by starting at the 10RM and removing weight (Oxford). The goal of this study was to examine the efficacy of each training method. DESIGN: In this randomized, prospective, group design, evaluator-blind clinical trial, 50 subjects performed either the Oxford or DeLorme weight-training techniques. Three times a week for 9 wks, subjects completed three sets of ten-repetition knee extensions based on the 10RM measured weekly. Incremental or decremental changes in training weight were utilized in training sessions based on the protocol randomly assigned to each subject. RESULTS: The mean 10RM increase was 71.9 kg for the DeLorme group and 67.5 kg for the Oxford group, which was not significantly different. Examination with repeated measures multivariate analysis of variance revealed no significant difference between the two groups for 10RM increase, and no significant sex differences were found. Percentage change scores were not significantly different for 1RM and 10RM for both protocols and sexes. CONCLUSION: Both protocol groups were able to complete their lifting assignments and progressed similarly in weekly 10RM weight lifted. It can be concluded that both the DeLorme and Oxford protocols improve strength with equivalent efficacy. Further studies involving a larger sample size are needed to address potential sex-specific changes in strength improvement in response to the protocols.

Correlation of standardized testing results with success on the 2001 American Board of Physical Medicine and Rehabilitation Part 1 Board Certificate Examination.

OBJECTIVE: To determine if standardized testing results and other factors correlate with success on the 2001 American Board of Physical Medicine and Rehabilitation part 1 board certification examination (POE). DESIGN: An anonymous two-part survey was distributed to 302 senior resident physicians in the American College of Graduate Medicine Education-accredited physical medicine and rehabilitation training programs in the United States deemed eligible for the 2001 POE. RESULTS: A total of 94 of 302 distributed surveys (31.1%) were returned; 86 met the inclusion criteria (81 passes and five failures). A significant correlation was found between both quartile ranking on the Self Assessment Examination and United States Medical Licensing Examination (USMLE) passage on the first attempt with POE quartile rank (P < 0.01). Other factors, such as number of hours of faculty-led didactics per week, textbook use, and participation in formal board review courses did not correlate with POE quartile ranking. CONCLUSION: Residents who were successful on previous standardized tests scored well on the POE. Quartile ranking on Self Assessment Examination and USMLE or National Board of Osteopathic Medical Examiners success was found to correlate significantly with POE quartile rank. This information may be helpful for future POE preparation and prospective candidate selection for physical medicine and rehabilitation.