factors at all. Emergent lumbar MRI was requested but wasdelayed 36 hours for insurance reason. Lumbar MRI showedhuge abscess from T10 to entire lumbar region and into psoasmuscles bilaterally. Emergent multilevel decompresson toevacuate the abscess was successful with no neurologicalsequal.Setting: Tertiary medical center.Results: Low back pain is common in outpatient practice. Itwas easy to consider him just like any other back pain patientespecially when there were no neurological deficits at thetime. I was puzzled by the subjective report of suddentransient positional weakness he had and thought he mighthave mass of some sort. I did not suspect abscess since thereis no fever or other risk factor such as prior spinal injection,intravenous drug use or diabetes. He had positive outcomewith our suspicion and early intervention.Discussion: Epidural abscess of this magnitude is almostunheard of, especially when no source is identifiable. Thiscase illustrates how crucial it is to consider mass lesionespecially in a patient who gives peculiar/unusual history. Inspite of negative risk factors, it is important to get imagingwhen the history and physical findings do not fit. There is noquestion a good history is the key. If the diagnosis wasdelayed for another day or two he could have died of sepsis orhad major spinal cord compromise.Conclusions: One should always suspect mass lesionwhen there is major weakness or sensory change withpositional change. Look further if the history and physicalfindings do not fit. One or 2 additional delays can bedisastrous.Keywords: Rehabilitation, Spine, Abscess, Weakness.

PROSTHETICS, ORTHOTICS, ASSISTIVEDEVICES

Poster 320

An Uncommon Gait Abnormality After ShortTrans-Tibial Amputation: A Case Report.Aditya Raghunandan, BS, MD (Naval MedicalCenter San Diego, San Diego, CA); BrianBelnap, DO; MIchael T. Mazurek, MD; MarilynnP. Wyatt, MA, PT.

Disclosures: A. Raghunandan, None.Patients or Programs: A 21-year-old man, active dutyU.S. Marine Corps.Program Description: While conducting military oper-ations during Operation Enduring Freedom, this patientsuffered severe traumatic injuries to his right leg fromdetonation of an improvised explosive device. As a resultof the extensive trauma, he required a very short righttrans-tibial amputation (TTA) with removal of the fibulaand its ligamentous attachment. The patient was cleared tostart weight bearing 6 weeks postoperatively and progressedto walking without an assistive device by 10 weeks. Physicalexamination of his right knee revealed well healed surgicalincisions, absent fibula, no gross instability of the knee joint,

normal range of motion, no tenderness to palpation andnormal gait using his prosthetist. As part of the routineamputee medical care in the C5 program, the patient under-went an instrumented 3-dimensional gait analysis at 5months post-operatively and was found to have a moderateto severe right knee varus thrust. Despite maximal conserva-tive treatments such as strengthening, prosthetic adjustmentsand revisions, he continued to experience a significant rightknee varus thrust.Setting: Tertiary care hospital.Results: The patient underwent a combined lateral collat-eral ligament (LCL) and posterior lateral corner reconstruc-tion of the knee. Additionally, prosthetics lateralized the footof his prosthetic to simulate a valgus proximal tibial osteot-omy. Following these interventions, the patient’s gait im-proved with significantly decreased right varus thrust.Discussion: This is the first reported case, to our knowl-edge, of varus thrust at the knee following a very short TTAwith proximal fibula excision that was effectively correctedby surgical and prosthetics intervention.Conclusions: Clinicians should consider obtaining a thor-ough gait lab assessment of patients with very short TTA andproximal fibula excision to evaluate for possible varus thrustdue to limitations in physical examination. Allograft recon-struction of the LCL and posterior lateral corner combinedwith lateralization of the prosthetic foot may decrease varusthrust and ultimately prevent early degenerative jointchanges of the knee in these patients.Keywords: Rehabilitation, Gait, Trans-tibial amputation,Lateral collateral ligament reconstruction.

Poster 321

Calciphylaxis Disguised as Phantom LimbPain: A Case Report.Jennifer Kendall, DO (University of Michigan, AnnArbor, MI); Brian M. Kelly, DO.

Disclosures: J. Kendall, None.Patients or Programs: A 55-year-old woman with lefttranstibial amputation with calciphylaxis confirmed by bi-opsy of her residual limb and a 63-year-old woman with lefttransfemoral amputation with clinical calciphylaxis of herresidual limb.Program Description: Calciphylaxis is a rare conditionseen most commonly in patients with end-stage renal disease(ESRD), resulting in vascular calcifications, thrombosis, andsoft tissue necrosis. Though ESRD is often a co-morbidity invasculopathic amputation, calciphylaxis has not been re-ported in this population. We present two cases of calciphy-laxis after lower extremity amputation from peripheral vas-cular disease. The patients presented with residual limb painconsistent with phantom limb pain. Both patients had nor-mal lab values for calcium, phosporous, and parathyroidhormone. Computed tomography imaging demonstratednon-specific soft tissue stranding. Collaboration with derma-tology and nephrology was necessary for diagnosis and treat-ment. The calciphylaxis was appropriately managed and

S243PM&R Vol. 1, Iss. 9S, 2009