Papers by Andrew Lederman
Pain Physician, 2016
Background: Headache (HA) is a significant cause of morbidity globally. Despite many available tr... more Background: Headache (HA) is a significant cause of morbidity globally. Despite many available treatment options, HAs that are refractory to conservative management can be challenging to treat. Third occipital nerve (TON) and greater occipital nerve (GON) irritation are potential etiologic agents of primary and cervicogenic HAs that can be targeted using minimally invasive treatment options such as nerve blocks or radiofrequency ablation. However, a substantial number of patients that undergo radiofrequency ablation do not experience pain relief despite a positive diagnostic medial branch block (MBB). Objective: In this study, we investigate the underlying cause for the high rate of false positives associated with MBBs by evaluating injectate spread in cadaveric subjects. Study Design: Cadaveric study. Setting: Academic medical center. Methods: After obtaining exemption status from our Institutional Review Board, TON injections were performed on 5 preserved cadavers, a total of 10 T...
The American Surgeon, 2016
The ability to return to work (RTW) postinjury is one of the primary goals of rehabilitation. The... more The ability to return to work (RTW) postinjury is one of the primary goals of rehabilitation. The modified Rankin Scale (mRS) is a validated simple scale used to assess the functional status of stroke patients during rehabilitation. We sought to determine the applicability of mRS in predicting RTW postinjury in a general trauma population. The trauma registry was queried for patients, aged 18 to 65 years, discharged from 2012 to 2013. A telephone interview for each patient included questions about employment status and physical ability to determine the mRS. Patients who had RTW postinjury were compared with those who had not (nRTW). Two hundred and thirty-four patients met the inclusion criteria. Of these, 171 (72.5%) patients RTW and 63 (26.7%) did nRTW. Patients who did nRTW were significantly older, had longer length of stay and higher rates of in-hospital complications. Multivariate analysis revealed that older patients were less likely to RTW (odds ratio = 0.961, P = 0.011) and...
Journal of Pain Research, 2019
Background: Morbidity has been reported as a sequelae of crystalline steroid epidural steroid inj... more Background: Morbidity has been reported as a sequelae of crystalline steroid epidural steroid injections (ESIs), and particulate steroid size, aggregation, and embolization in brain and spinal cord may be the mechanism related to these neurologic effects. Objective: The objective of the study was to examine the aggregation properties of triamcinolone acetonide in commonly used local anesthetics with and without human serum. Setting: This study was conducted in an academic tertiary care center. Hypothesis: Triamcinolone acetonide shows different aggregation characteristics in serum compared to a non-physiologic solution. Design: Triamcinolone acetonide was mixed with lidocaine 1% (first group) and bupivacaine 0.5% (second group) in a 1:1 ratio and then mixed with either distilled water (control group) or serum ex vivo. A pathologist blinded to our hypothesis inspected all solutions under light microscopy with 100× and 400× magnifications. Total number of particulate steroid aggregates and the number of particles forming each aggregate (recorded as single, 1 double, 2 triple, 3 quadruple, 4 or large [>4} crystals) were counted. Particle size and aggregate size were measured (in μm). The ratios of quadruple to total aggregates, large to total, and quadruple with large to total aggregates were calculated. Steroid-serum solutions and steroid-sterile water were then compared. Results: Triamcinolone aggregates showed an increased crystal and aggregate size when compared with other steroids. Within the triamcinolone subgroup, the mixture of lidocaine 1% and serum resulted in the largest crystal aggregates. Limitations: Whole blood analysis may have provided a more physiologically accurate model but was not chosen due to poor microscopic analysis. Serum donor variability may also have affected particle characteristics. Conclusion: Fewer large triamcinolone aggregates were noted in the presence of serum when compared to the non-serum control groups. However, when compared to previously studied particulate steroids, it had the largest aggregates when added to serum.
Journal of rehabilitation research and development, 2016
We present the case of a 24 yr old male who was diagnosed with gluteal compartment syndrome and w... more We present the case of a 24 yr old male who was diagnosed with gluteal compartment syndrome and was subsequently found to have developed lumbosacral radiculoplexopathy and complex regional pain syndrome. The patient's gluteal compartment syndrome was diagnosed within 24 h of presentation to the emergency room, and he underwent emergent compartment release. While recovering postoperatively, persistent weakness was noted in the right lower limb. Results of electrodiagnostic testing were consistent with a lumbosacral radiculoplexopathy. After admission to inpatient rehabilitation, the patient complained of pain, burning sensation, and numbness in the distal right lower limb. Based on clinical findings, he was diagnosed with complex regional pain syndrome type II, or causalgia, and was referred for a lumbar sympathetic block under fluoroscopic guidance. Sympathetic block resulted in relief of the patient's symptoms. He was discharged home with good pain control on oral medications.
PM&R, 2015
A 28-year-old man with no significant medical history presents to the spine clinic after sustaini... more A 28-year-old man with no significant medical history presents to the spine clinic after sustaining a skiing-related injury. He jumped out of a helicopter to ski the back bowls of Vail and developed immediate lower back pain but was able to ski down the mountain. The same evening, he noticed radiating pain from the right lower back, buttock, and posterolateral thigh to the right calf. In addition he reported an antalgic gait and decreased toe push-off strength. The patient presents in the clinic 5 days after the onset of symptoms and reports nearcomplete resolution of pain with no bowel/bladder involvement, and he does not report getting any weaker. On examination, the patient has an absent right Achilles reflex. He is unable to complete 1 single-leg heel raise on the right, although he is able to dorsiflex his ankle and his extensor hallicus longus strength is 4/5. Magnetic resonance imaging (MRI) of the lumbar spine reveals a right L5-S1 paracentral disk extrusion compressing the S1 nerve root in the lateral recess, but relative sparing of the remainder of the spinal canal. At this point, what do you recommend: surgery or continued nonsurgical care? Drs Sayed Wahezi and Andrew Lederman will argue that this patient likely suffers from a self-limiting radiculopathy and, with nonoperative care, should regain full function. Dr Eric H. Elowitz suggests that early operative management will deliver the greatest functional outcome in this case scenario.
PM&R, 2014
patients 377 (80.1%) sustained their injuries as a result from motor vehicle accidents. Cervical ... more patients 377 (80.1%) sustained their injuries as a result from motor vehicle accidents. Cervical cord was the most common site of injury accounting for 34% (n¼137) of cases in male population, and in females, the higher frequency was the upper thoracic (n¼31 [45.6%]) There were 250 TSCI patients that stayed in the hospital for 1-70 days, and only 12 patients stayed in hospital for >280 days. Conclusions: Compared to females, the frequency of TSCI was higher in males, and younger group sustained more TSCI. Road traffic accident is the most common cause of injury, and more than 50% of the TSCI patients stayed in the hospital for <70 days.
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Papers by Andrew Lederman