Risk of SARS-CoV-2 following joint and epidural corticosteroid injections: A retrospective study.

OBJECTIVE: The immunosuppressive effects of corticosteroid (CS) injections have come under more scrutiny during the coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to explore any relationship between joint/epidural CS injection and SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction (PCR) positivity. METHODS: A retrospective chart review was conducted on patients 18 years or over who received at least one joint or epidural CS injection by physiatrists in a tertiary care center between January 1, 2020, and December 31, 2021. This cohort of patients was then compared to a control group who did not receive any CS injection during this time period. RESULTS: A total of 766 patients were identified in the CS injection group and 1546 patients in the control group. Overall, 12.27% of patients turned SARS-CoV-2 PCR positive in the CS injection group, which was similar to 11.90% in the control group (p = 0.797). But 3-month SARS-CoV-2 PCR positivity rate showed a statistically significant higher rate among the CS injection group (3.30% in the CS injection group vs. 2.10% in the control group; p = 0.027). In multivariate regression analysis, after adjusting both groups for Charlson Comorbidity Index (CCI), there was statistically significant higher SARS-CoV-2 PCR positivity rate in the CS injection group (p = 0.024). However, after adjusting both groups for age and total number of comorbidities, there was no difference between the groups in regard to SARS-CoV-2 PCR positivity rate (p = 0.081). In the subgroup analysis of only COVID-19 vaccinated patients, there was an increased 3-month SARS-CoV-2 PCR positivity rate among patients with severe comorbidities in the CS injection group (p = 0.036). CONCLUSION: The study was not conclusive on the effect of joint or epidural CS injection on SARS-CoV-2 PCR positivity rate, although adjusted analysis suggests higher 3-month SARS-CoV-2 PCR positivity rate after CS injection in patients with severe comorbidities with significant disease burden when compared to controls.

Changes in the Utilization of Lumbosacral Epidural Injections Between 2010 and 2019.

STUDY DESIGN: A descriptive epidemiologic study. OBJECTIVE: To analyze trends and patient characteristics for lumbosacral transforaminal and interlaminar/caudal epidural injection utilization over time. BACKGROUND: Lumbosacral transforaminal and interlaminar/caudal epidural injections are considered for varying lumbar pathologies. Reported studies, physician practices, insurance authorization, and other factors may influence utilization patterns over time. METHODS: Patients undergoing lumbosacral transforaminal and interlaminar/caudal epidural injections between 2010 and 2019 were identified in the M91Ortho PearlDiver database based on Current Procedural Terminology coding. Patient age, sex, Elixhauser Comorbidity Index (ECI), insurance plan (commercial, Medicaid, Medicare), and region of the country where the procedure was performed (Midwest, Northeast, South, West) were assessed and tracked over the years studied based on prevalence per 100,000 covered lives. RESULTS: Lumbosacral transforaminal and interlaminar/caudal epidural injections were identified for 426,039 and 501,228 patients, respectively. The number of injections performed per year decreased over the years studied: for transforaminal injections from 160.81 to 76.36 per 100,000 patients and for interlaminar/caudal injections from 200.53 to 77.56 per 100,000 patients. The decrease in overall injections was greatest for those with Commercial and Medicare coverage (53.40% and 66.50%, respectively), with a smaller drop amongst those with Medicaid coverage (32.39%).Over the years, the average patient undergoing injection was older and there was a relative shift toward transforaminal injections ( P <0.05 for both). In terms of specialty of those performing the injections, they were mostly performed by Anesthesiology specialists (who performed less transforaminal than interlaminar/caudal injections). CONCLUSION: Lumbosacral transforaminal and interlaminar/caudal spinal epidural injections were shown to decrease by 52.37% per 100,000 patients from 2010 to 2019. Changing demographics of those undergoing such injections and practice patterns are important to consider in the picture of overall spine service utilization. Variations in injection utilization trends by patient insurance raise questions regarding disparities in care.

Atypical knee pain.

The patient found it hard to climb stairs-and to complete a particular task when getting dressed. Difficulty with that task provided a useful diagnostic clue.

Is there an association between lumbosacral epidural lipomatosis and lumbosacral epidural steroid injections? A comprehensive narrative literature review.

BACKGROUND: Exogenous systemic steroid exposure is a well-established risk factor for spinal epidural lipomatosis (SEL), however the association between lumbosacral epidural steroid injections (LESIs) and lumbosacral epidural lipomatosis (LEL) is generally regarded as poorly understood. Our objective was to investigate the rationale and the evidence implicating LESI(s) as a potential cause of LEL as well as the evidence related to use of LESI(s) as a potential pain relieving treatment option for radicular pain in the setting of LEL. METHODS: PubMed, Embase, Google Scholar, OVID were searched from inception until April 2021. Three investigators identified literature that provided original descriptive patient clinical data attributing the development/progression of LEL to LESI(s) or described the use of LESI(s) as a pain relieving modality for radicular pain in the setting of LEL. RESULTS: Fourteen publications were included for review. Overall, the current level of evidence is of low-quality. There are significant methodological gaps on this subject matter and many studies do not account for confounding variables independently associated with LEL. CONCLUSIONS: This review has identified substantial limitations in the literature regarding that which is truly known regarding LESI(s) and LEL, as well as conservative management overall. To provide a well-rounded perspective, we synthesized literature as it pertains to: 1) current knowledge regarding SEL, notable associations and potential implications for corticosteroid exposure; 2) corticosteroid exposure and lipoatrophy; 3) current management recommendations for SEL and 4) areas for future focus. Although LESI(s) have been associated with LEL in the literature, presently due to a lack of rigorous, high-quality studies, the presence or absence of an independent causal relationship between LESI(s) and LEL cannot be stated with confidence.

Clinical and Anatomical Considerations for Management of a Complete Tear of the Distal Rectus Femoris Myotendinous Junction: A Rare Knee Extensor Mechanism Injury.

ABSTRACT: The knee extensor mechanism is a highly complex multilayered and reinforced structure. Quadriceps muscle injuries are considered to be common, particularly among athletes; however isolated rectus femoris injuries involving the distal myotendinous junction are considered to be exceedingly rare with very few case reports published to date. Thus, the presentation and diagnosis of this injury can be elusive and treatment is nonuniform. There is limited literature published advocating both nonsurgical and surgical management. We illustrate the clinical and radiologic presentation of a traumatic, nonsport-related distal rectus femoris muscle injury treated operatively. The presentation of this injury along with anatomical and clinical considerations is portrayed in detail. This case report contributes to the sparse literature regarding this injury and delineates management considerations.

Abdominal wall Type-I complex regional pain syndrome treated effectively with peripheral nerve field stimulation: a case report.

Chronic abdominal wall pain is a well-documented complication of abdominal surgery. However, abdominal wall complex regional pain syndrome (CRPS) is a rare medical condition. We present a case of abdominal wall CRPS and its treatment with peripheral nerve field stimulation (PNfS). A 34-year-old female presented with right periumbilical pain for 2 years. She developed burning, sharp and stabbing pain with allodynia (extremely sensitive to wind and light touch) and erythema or pallor 2 weeks after an exploratory appendectomy. The extensive evaluation ruled out the underlining pathology. After she failed conservative therapies, she underwent a 7-day trial of thoracic spinal cord stimulation (SCS) and abdominal wall PNfS. Thoracic SCS failed to provide pain relief; however, PNfS provided significant relief (>90%) of burning sensation. It has now been 5 years since the PNfS was implanted and she continues to demonstrate substantial pain relief.

Acute Disseminated Encephalomyelitis in an Adult: An Uncommon Case of Paroxysmal Sympathetic Hyperactivity.

Acute disseminated encephalomyelitis (ADEM) is an uncommon acute, rapidly progressive autoimmune demyelinating disease of the central nervous system that is most often due to infection or immunization. Generally, it is monophasic, but there is potential for recurrence and risk for development of multiple sclerosis. Although there has been literature documenting autonomic dysreflexia and hypertensive emergency in 2 pediatric cases of ADEM, to our knowledge there has not been a case detailing paroxysmal sympathetic hyperactivity in an adult patient with ADEM. This case report describes a fulminant case of ADEM and serves to expand the list of diagnoses associated with paroxysmal sympathetic hyperactivity.