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. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: Adults (n=9,196) who received a spinal CSI (epidural, facet, sacroiliac, paravertebral block) during influenza seasons occurring from 2000 to 2020 were 1:1 matched to controls without spinal CSI. OUTCOME MEASURES: The primary outcome was odds of influenza diagnosis in spinal CSI patients compared to matched controls. Predetermined subgroup analyses examined odds of influenza diagnosis based on vaccination status and injection location. METHODS: An institutional database was queried to identify patients that received spinal CSI during influenza season (September 1 to April 30) from 2000 to 2020. Patients were matched by age, sex, and influenza vaccination status to controls without spinal CSI within the specified influenza season. Influenza diagnosis was ascertained using International Classification of Disease codes and data was analyzed using multiple logistic regression adjusted for comorbidities associated with increased risk for influenza. RESULTS: A total of 9,196 adults (mean age 60.8 years, 60.4% female) received a spinal CSI and were matched to a control. There were no increased odds of influenza for spinal CSI patients as compared to matched controls (OR 1.13, [95% CI, 0.86-1.48]). When subgroups were examined, there were also no increased odds of influenza for spinal CSI patients based on immunization status (unvaccinated or vaccinated) or spinal injection location (epidural or non-epidural). CONCLUSIONS: Spinal region CSI was not associated with increased odds of influenza or reduced vaccine efficacy. This is reassuring given the analgesic and functional restoration benefits of these injections. Assessing risk of viral infection associated with spinal CSI is particularly relevant in the era of the COVID-19 pandemic, and further work is needed to address this issue.

Chylothorax complicating inpatient rehabilitation after thoracic spinal cord injury: a review of risk factors and anatomy for the physiatrist.

After malignancy, traumatic and surgical injuries to the upper abdomen and chest are the leading causes of chylothorax. Thoracic spine extension injury, blunt or penetrating chest trauma, anterior thoracic spine surgery, and increased intra-abdominal pressure have all been implicated in the development of chylothorax. Despite the physiatrist's frequent exposure to polytrauma and postsurgical patients, there are no case reports of chylothorax complicating inpatient rehabilitation or occurring in a patient fitted in a thoracic or lumbar orthosis. We present the case of a patient with traumatic spinal cord injury from a high-speed motor vehicle accident who was diagnosed with a left-sided chylothorax while wearing a thoracolumbosacral orthosis 4 wks into her inpatient rehabilitation stay. Knowledge of the anatomy of the thoracic duct can be useful for diagnosing chylothorax in patients with thoracic spine fractures, upper abdomen/chest injury, or thoracic surgery, as the trajectory of the duct often determines the location of pleural effusion.

Freiberg's disease as a rare cause of limited and painful relevé in dancers.

Freiberg's disease, or osteonecrosis of the second metatarsal head, is an uncommon cause of forefoot pain that can severely limit a dancer's relevé. Dancers may be predisposed to the condition due to repetitive microtrauma to the ball of the foot during routine dance movements. Freiberg's disease is diagnosed by history, physical examination, and plain film radiographs. Conservative treatment in dancers is disappointing, and surgical options fail to produce uniformly good results. Previously published reports of successful surgical outcomes would, for a dancer, result in an unacceptable loss of dorsiflexion of the MTP joint. This first case report of Freiberg's disease in a dancer serves to discuss the orthopaedic and artistic implications of managing the disease in a young, active, adolescent dancer. A new surgical treatment involving modification of Mann's cheilectomy, normally used for hallux rigidus, is presented. The operation corrected the patient's pain, completely normalized the aberrant relevé, allowed her to resume dance training within three weeks, and return to full dance activity within three months.