Spinal corticosteroid injections are not associated with increased influenza risk.

Background Context: Spinal corticosteroid injections (CSI) are often used to treat radicular and axial pain arising from the spine. Systemic corticosteroids are well known to cause immunosuppression, and locally injected spinal CSI are known to have some systemic absorption. However, it is unknown whether spinal CSI increases the risk of systemic viral infections, such as influenza.

Spinal region corticosteroid injections are not associated with increased risk for influenza.

Background Context: Spinal region corticosteroid injections (CSI) are intended to act locally to relieve radicular or axial back pain, however some systemic absorption occurs, potentially placing recipients at risk for immunosuppressive effects of corticosteroids. No previous studies examine whether patients undergoing spinal region CSI are at increased risk for viral infections, particularly influenza-a common viral illness with potentially serious consequences, especially for patients with multimorbidity.

Purpose: To examine odds of influenza in patients who received spinal region CSI compared to matched controls.

Adverse events associated with fluoroscopically guided lumbosacral transforaminal epidural steroid injections.

Background Context: Although the types and incidence of adverse events (AEs) associated with transforaminal epidural steroid injection (TFESI) have been described, no study has used a systematic standardized questionnaire to solicit AEs from patients to capture an accurate range and incidence of complications.

Purpose: The aim was to systematically identify the types and incidence of AEs associated with TFESI. Additionally, this study evaluated demographic and clinical factors that may predict a higher risk of an AE.

Adverse events associated with fluoroscopically guided zygapophyseal joint injections.

Background: In spite of the widespread performance of intra-articular zygapophyseal joint (IAZJ) injections, we know of no systematic analysis to date that examines the risks and types of adverse events when IAZJ injections are performed.

Objective: To describe the type, incidence, and factors contributing to adverse events associated with fluoroscopically guided IAZJ injections.

Study Design: A retrospective, cohort study of English-speaking adults aged 18 - 90 years who underwent fluoroscopically guided IAZJ injections between March 8, 2004, and April 19, 2007.

Comparative effectiveness of lumbar transforaminal epidural steroid injections with particulate versus nonparticulate corticosteroids for lumbar radicular pain due to intervertebral disc herniation: a prospective, randomized, double-blind trial.

Background: Lumbar transforaminal epidural injections are commonly utilized to treat radicular pain due to intervertebral disc herniation.

Objective: This study aims to determine if there was a major difference in effectiveness between particulate and nonparticulate corticosteroids for acute radicular pain due to lumbar disc herniation.

Design: A multicenter, double blind, prospective, randomized trial on 78 consecutive subjects with acute uni-level disc herniation resulting in unilateral radicular pain.

Vasovagal rates in flouroscopically guided interventional procedures: a study of over 8,000 injections.

Objective: To determine the rate of vasovagal (vv) complications in fluoroscopically guided interventional procedures.

Design: Retrospective case series analysis of prospectively collected data from March 8, 2004 to January 30, 2009.

Setting: A single academic medical center.

Programmatic design for teaching the introductory skills and concepts of lumbar spine procedures to physiatry residents: a prospective multiyear study.

Objective: The objective of this study was to determine the effectiveness of a 2-day course teaching the introductory skills and concepts of lumbar spine procedures to physiatry residents.

Design: This is a 3-yr prospective study of a 2-day musculoskeletal course teaching the introductory skills and concepts of lumbar spinal procedures to the residents at a large academic physical medicine and rehabilitation program. The residents attending the course took multiple-choice pretests and posttests as well as participated in a procedural skills competency demonstration.

Adverse events associated with fluoroscopically guided sacroiliac joint injections.

Objective: To describe the type, incidence, and factors that contribute to adverse events associated with fluoroscopically guided intra-articular sacroiliac joint injections (IASIJ).

Design: A retrospective cohort study.

Setting: Tertiary, academic, outpatient physical medicine and rehabilitation interventional spine clinic.

The role of exercise and alternative treatments for low back pain.

The determination of whether a patient should pursue an active or passive treatment program is often made by medical practitioners. Knowledge about all forms of treatment, including complementary and alternative (CAM) treatments, is essential in the treatment of low back pain. Medical practitioner-directed active treatments that have been shown to be effective for the treatment of low back pain include physical therapy-directed exercise programs such as core stabilization and mechanical diagnosis and therapy (MDT).

Inadvertent intradiscal contrast flow during lumbar transforaminal epidural steroid injections: a case series examining the prevalence of intradiscal injection as well as potential associated factors and adverse events.

Objectives: The primary aim was to evaluate the prevalence of inadvertent intradiscal injection during fluoroscopically guided contrast-enhanced lumbar transforaminal epidural steroid injections. The secondary aim was to determine if there are any risk factors for or adverse events as a result of inadvertent intradiscal contrast injection.

Design: The study was a retrospective case series.

Utility of the anesthetic test dose to avoid catastrophic injury during cervical transforaminal epidural injections.

Background Context: Reports of serious complications from cervical transforaminal epidural corticosteroid injections often consider accidental intra-arterial injection the most likely mechanism of injury. As a result, many physicians have instituted methods to prevent intravascular injections. Routine use of the anesthetic test dose is one such method.

Efficacy of lumbosacral transforaminal epidural steroid injections: a systematic review.

Objective: To critically review the best available studies evaluating the efficacy of lumbosacral transforaminal epidural steroid injections (TFESIs) in the treatment of radicular pain.

Data Sources: MEDLINE, EMBASE, and the Cochrane database were searched for the period between 1950 and May 2008. Search terms included epidural steroid injection (ESI), transforaminal ESI, foraminal ESI, selective nerve root block, nerve root injection (NRI), selective NRI, periradicular infiltration, and periradicular injection.

The rate of detection of intravascular injection in cervical transforaminal epidural steroid injections with and without digital subtraction angiography.

Objective: To determine whether digital subtraction angiography (DSA) combined with real-time fluoroscopic imaging improves the detection rate of intravascular injection during cervical transforaminal epidural steroid injections (CTFESIs).

Design: Retrospective analysis.

Setting: Outpatient surgery center.

Comprehensive functional evaluation of the injured runner.

In most cases, a detailed history provides the information that is necessary for the clinician to diagnose the injured runner correctly; however, to treat the injury and guide a successful rehabilitation program, the physical examination must go beyond the standard regional musculoskeletal examination. The victims (tissue injury) and the culprits (biomechanical deficits) must be identified to facilitate treatment (Table 3). Gait and other dynamic assessments help to reveal underlying deficits in function that may have contributed to injury.

Worsening myelopathy masked by peripheral nerve disorders.

Background/objective: Peripheral nerve disorders--whether due to peripheral nerve entrapment or to polyneuropathy--can alter the signs of myelopathy, masking both the sensory loss and distal hyperreflexia. Diagnosis of worsening myelopathy may be missed when there is a coexisting peripheral nerve disorder.

Methods: This study is a case description and analysis of 3 consecutive cases identified over 2 years.

Functional rehabilitation for degenerative lumbar spinal stenosis.

Nonoperative treatment for lumbar spinal stenosis must address anatomic and biomechanical factors. The entire functional kinetic chain and patient specific goals must be considered. In addition to passive modalities, manual therapy, and patient education, an active program consisting of flexion-based lumbar stabilization exercises, hip mobilization, proprioceptive training, and general conditioning should be initiated.

Radiation exposure of the spinal interventionalist performing fluoroscopically guided lumbar transforaminal epidural steroid injections.

Objective: To evaluate radiation exposure to spinal interventionalists while performing transforaminal epidural steroid injections (TFESIs).

Design: Prospective study.

Setting: Multidisciplinary spine center.