Aaron Jay Yang

Background: Lumbar radicular pain is often treated with interlaminar epidural particulate corticosteroid injection (ILEPSI). However, little literature exists on epidural tissue changes post ILEPSI. Investigating these potential tissue changes is valuable because of their possible clinical implications. Objective: To report gross and histological epidural tissue changes after ILEPSI following spinal decompression surgery and compare the observed changes to those previously reported in the literature. Design: A retrospective case series and systematic literature review were conducted. Surgeons were blinded to the details of corticosteroid injections and the study's specific aims. Participants: Patients who underwent spinal decompression surgery and through retrospective chart review were found to have had ILEPSI prior to surgery. Methods: Four consecutive patients undergoing spinal decompression surgery were included in a convenience sample, all exhibiting abnormal epidural tissue formation. A retrospective chart review showed that each patient had received ILEPSI at the same spinal level before surgery. A systematic literature review, registered in International Prospective Register of Systematic Reviews, was subsequently conducted based on this novel finding. Results: Surgical biopsies from four patients undergoing spinal decompression after ILEPSI showed “granulomatous‐like reactions” in the epidural space. A systematic literature review found no similar epidural reactions but did find comparable findings in dermatology literature. Conclusion: The epidural “granulomatous‐like reactions” observed after ILEPSI are a novel finding, resembling tissue reactions from particulate corticosteroid administration. This suggests a potential link between ILEPSI and these reactions.

Background: Residency choice is often influenced by experiences in medical school. It is unclear what potential factors contribute to medical schools producing higher numbers of physical medicine & rehabilitation (PM&R) residents.Objective: To identify the medical schools producing the most PM&R residents from 2017 to 2021 and potential influencing factors toward this production.Design: Descriptive, cross‐sectional study.Setting: Accreditation Council for Graduate Medical Education accredited PM&R programs; allopathic/osteopathic/international medical schools.Interventions: REDCap Survey.Participants: Representatives from medical schools producing the most PM&R residents.Methods: The medical schools that produced the most PM&R residents from 2017 to 2021 were identified using publicly available information on the internet. A subgroup of the highest producing schools were surveyed to determine potential factors that contributed to production of PM&R residents.Main Outcome Measure: Medical schools with the highest number of matriculated PM&R residents from 2017 to 2021; potential factors influencing matriculating PM&R residents.Results: The medical school that produced the most PM&R residents from 2017 to 2021 was New York Institute of Technology College of Osteopathic Medicine. Nine of the 11 medical schools producing the most PM&R residents were osteopathic. Of osteopathic graduates applying to residency, 2.87% matriculated into PM&R residencies compared to 1.21% of allopathic graduates (p < .001), though a greater number of allopathic graduates overall were represented. Among survey respondents 93.3% (14/15) attributed exposure to PM&R faculty/residents and exposure to PM&R through medical school curriculum as perceived factors contributing to production of PM&R residents.Conclusion: Osteopathic medical schools accounted for most of the schools producing the highest number of PM&R residents. A statistically significant higher percentage of osteopathic graduates were found to pursue PM&R as a career compared to allopathic counterparts although the total number of students entering PM&R was greater from allopathic schools. Potential factors contributing to medical students pursuing PM&R included faculty/resident involvement with medical students, and PM&R exposure through curriculum or interest groups.

Table 2 sgRNA genes and sequences