Gerard P. Varlotta, D.O.

Interlaminar versus transforaminal epidural steroids for the treatment of subacute lumbar radicular pain: A randomized, blinded, prospective outcome study
Gharibo C.G.; Varlotta G.P.; Rhame E.E.; Liu E.-C.J.; Bendo J.A.; Perloff M.D.
2011 ;14(6):499-511, Pain Physician
Background: There is uncertainty in the literature over the relative effectiveness of lumbar epidural interlaminar (IL) steroid injection versus transforaminal (TF) steroid injection for lumbar radiculopathy. Most studies to date have been retrospective, or technically focused. Objective: To complete a randomized, blinded, prospective outcome study of the short-term benefit for IL versus TF epidural steroids for the treatment of subacute lumbar radicular pain. Study design: Prospective, randomized, blinded, subacute efficacy trial. Setting: Tertiary care pain management center, major metropolitan city, United States Methods: After institutional review board approval, 42 age-matched patients with similar lower back pain and unilateral radicular symptoms were enrolled and randomized in a patient and evaluating physician blinded trial to IL or TF epidural steroids from 2007 through 2009. Prior to intervention and 10-16 days after injection, each participant was evaluated by questionnaire and physical exam by an independent physician. All injections were performed by the same physician. Thirty-eight participants completed the study, 18 in the IL group and 20 in the TF group. Four participants required a repeat injection, and 2 participants crossed over to the alternative injection type (IL to TF). Results: Overall, physical exam, diagnostic testing, disability, activity, depression measures, and opioid pill use were similar between the 2 groups, both pre-injection baseline and postinjection improvement. In primary outcomes, the post-injection follow-up Numeric Rating Scale (NRS) was more greatly reduced in the TF group. The NRS decreased from 7.0 +/- 1.9 to 3.9 +/- 3.1 (mean values +/- standard deviation) in the IL group and 6.4 +/- 2.1 to 1.7 +/- 1.4 in the TF group. The Oswestry Disability Index was reduced from 37.5 +/- 12.6 to 19.0 +/- 16.7 in the IL group and 38.3 +/- 6.4 to 21.6 +/- 16.8 in the TF group. In secondary outcomes, the depression scale was reduced from 4.39 +/- 3.22 to 2.28 +/- 3.20 in the IL group and 4.10 +/- 1.94 to 1.65 +/- 1.63 in the TF group. Walking tolerance was increased from 8.1 +/- 4.6 blocks to 10.6 +/- 4.4 in the IL group and 8.9 +/- 5.3 blocks to 11.8 +/- 4.2 in the TF group. Limitations: The study did not examine long-term outcomes. A single experienced interventionalist performed all injections. Conclusion: Results suggest that patients may experience greater subjective relief, at least initially, from TF epidural steroid injections over IL. However, more objective, and likely subacute, therapeutic effects are similar
— id: 145743, year: 2011, vol: 14, page: 499, stat: Journal Article,

Interlaminar versus transforaminal epidural steroids for the treatment of subacute lumbar radicular pain: a randomized, blinded, prospective outcome study
Gharibo, Christopher G; Varlotta, Gerald P; Rhame, Ellen E; Liu, En-Chia James; Bendo, John A; Perloff, Michael D
2011 Nov;14(6):499-511, Pain Physician
BACKGROUND: There is uncertainty in the literature over the relative effectiveness of lumbar epidural interlaminar (IL) steroid injection versus transforaminal (TF) steroid injection for lumbar radiculopathy. Most studies to date have been retrospective, or technically focused. OBJECTIVE: To complete a randomized, blinded, prospective outcome study of the short-term benefit for IL versus TF epidural steroids for the treatment of subacute lumbar radicular pain. STUDY DESIGN: Prospective, randomized, blinded, subacute efficacy trial. SETTING: Tertiary care pain management center, major metropolitan city, United States METHODS: After institutional review board approval, 42 age-matched patients with similar lower back pain and unilateral radicular symptoms were enrolled and randomized in a patient and evaluating physician blinded trial to IL or TF epidural steroids from 2007 through 2009. Prior to intervention and 10-16 days after injection, each participant was evaluated by questionnaire and physical exam by an independent physician. All injections were performed by the same physician. Thirty-eight participants completed the study, 18 in the IL group and 20 in the TF group. Four participants required a repeat injection, and 2 participants crossed over to the alternative injection type (IL to TF). RESULTS: Overall, physical exam, diagnostic testing, disability, activity, depression measures, and opioid pill use were similar between the 2 groups, both pre-injection baseline and post-injection improvement. In primary outcomes, the post-injection follow-up Numeric Rating Scale (NRS) was more greatly reduced in the TF group. The NRS decreased from 7.0 +/- 1.9 to 3.9 +/- 3.1 (mean values +/- standard deviation) in the IL group and 6.4 +/- 2.1 to 1.7 +/- 1.4 in the TF group. The Oswestry Disability Index was reduced from 37.5 +/- 12.6 to 19.0 +/- 16.7 in the IL group and 38.3 +/- 6.4 to 21.6 +/- 16.8 in the TF group. In secondary outcomes, the depression scale was reduced from 4.39 +/- 3.22 to 2.28 +/- 3.20 in the IL group and 4.10 +/- 1.94 to 1.65 +/- 1.63 in the TF group. Walking tolerance was increased from 8.1 +/- 4.6 blocks to 10.6 +/- 4.4 in the IL group and 8.9 +/- 5.3 blocks to 11.8 +/- 4.2 in the TF group. LIMITATIONS: The study did not examine long-term outcomes. A single experienced interventionalist performed all injections. CONCLUSION: Results suggest that patients may experience greater subjective relief, at least initially, from TF epidural steroid injections over IL. However, more objective, and likely subacute, therapeutic effects are similar
— id: 141704, year: 2011, vol: 14, page: 499, stat: Journal Article,

Interlaminar versus transforaminal epidural steroids for the treatment of lumbar radicular pain: A randomized, blinded, prospective outcome study
Perloff M.; Varlotta G.; Gharibo C.
2011 ;12(4 SUPPL 1):P65-P65, Journal of pain
Argument in the literature exists over lumbar epidural interlaminar steroid injection (LESI) verses transforminal (TF) technique as the most effective therapy in lumbar radiculopathy. However, all studies to date have been retrospective. After IRB approval, 42 age matched patients with similar lower back pain and unilateral radicular symptoms were enrolled and randomized in a double blind trial to LESI or TF from 2007 to 2009. Prior to intervention and 10-16 days after injection, each patient was evaluated by patient questionnaire and physical exam by an independent physician. 38 patients completed the study, 18 in the LESI and 20 in the TF group. In both groups, 2 patients required repeat injection, and 1 patient crossed over to the alternative injection type. Overall, physical exam, diagnostic testing, disability, activity and depression measures, and opioid pill use, were similar between the 2 groups, both pre-injection baseline and post-injection improvement. The Oswestry Disability Index (ODI%) was reduced from 37.5+/-12.6 (mean values +/- standard deviation) to 19.0+/-16.7 (49.3%+/-39.2%) in the LESI group and 38.3+/-6.4 to 21.6+/-16.8 (43.7%+/-34.8%) in the TF group. Depression scale was reduced from 4.39+/-3.22 to 2.28+/-3.20 (48.1%+/-52.0%) in the LESI group and 4.10+/-1.94 to 1.65+/-1.63 (61.0%+/-39.1) in the TF group. Walking tolerance was increased from 8.1+/-4.6 blocks to 10.6+/-4.4 (30.8%+/-133.2%) in the LESI group and 8.9+/-5.3 blocks to 11.8+/-4.2 (32.8%+/-318.7%) in the TF group. The follow-up patient numerical rating scale (NRS) was more greatly reduced in the TF group. NRS decreased from 7.0+/-1.9 to 3.9+/-3.1 (44.4%+/-37.6) in the LESI group and 6.4+/-2.1 to 1.7+/-1.4 in the TF group (73.2%+/-21.3%). Overall, results suggest that patients may experience greater subjective relief, as least initially, from TF epidural steroid injections over LESI. However, more objective, and likely subacute, therapeutic effects are similar
— id: 131849, year: 2011, vol: 12, page: P65, stat: Journal Article,

The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading
Varlotta, Gerard P; Lefkowitz, Todd R; Schweitzer, Mark; Errico, Thomas J; Spivak, Jeffrey; Bendo, John A; Rybak, Leon
2011 Jan;40(1):13-23, Skeletal radiology
We present a two-part review article on the current state of knowledge of lumbar facet joint pathology. This first article discusses the functional anatomy, biomechanics, and radiological grading systems currently in use in clinical practice and academic medicine. Facet joint degeneration is presented within the larger context of degenerative disc disease to enable the reader to better understand the anatomical changes underlying facet-mediated lower back pain. Other less-common, but equally important etiologies of lumbar facet joint degeneration are reviewed. The existing grading systems are discussed with specific reference to the reliability of CT and MR imaging in the diagnosis of lumbar facet osteoarthritis. It is hoped that this discussion will stimulate debate on how best to improve the diagnostic reliability of these tests so as to improve both operative and non-operative treatment outcomes
— id: 114816, year: 2011, vol: 40, page: 13, stat: Journal Article,

The lumbar facet joint: a review of current knowledge: Part II: diagnosis and management
Varlotta, Gerard P; Lefkowitz, Todd R; Schweitzer, Mark; Errico, Thomas J; Spivak, Jeffrey; Bendo, John A; Rybak, Leon
2011 Feb;40(2):149-157, Skeletal radiology
This article is the second article in a two-part review on lumbar facet joint pathology. In this review, we discuss the current concepts and controversies regarding the proper diagnosis and management of patients presenting with presumed facet-mediated lower back pain. All efforts were made to include the most relevant literature from the fields of radiology, orthopaedics, physiatry, and pain management. Our focus in this article is on presenting the evidence supporting or refuting the most commonly employed injection-based therapies for facet-mediated lower back pain
— id: 116219, year: 2011, vol: 40, page: 149, stat: Journal Article,

Rehabilitation of orthopaedic and neurologic boxing injuries
Lefkowitz, Todd; Flanagan, Steven; Varlotta, Gerard
2009 Oct;28(4):623-39, vii, Clinics in sports medicine
Clinical decision making for injured boxers follows the same therapeutic principles as the treatment plan for other injured athletes. Just as surgical techniques have improved, so has the scientific basis for implementing therapeutic exercises progressed to return the athletes to their former level of competition
— id: 104356, year: 2009, vol: 28, page: 623, stat: Journal Article,

Medical Issues in Boxing Preface
Varlotta, GP; Jordan, B
2009 OCT ;28(4):XI-XII, Clinics in sports medicine
— id: 105233, year: 2009, vol: 28, page: XI, stat: Journal Article,

Successful treatment of phantom radiculopathy with fluoroscopic epidural steroid injections
Aydin, Steve M; Zou, Sheng Ping; Varlotta, Gerard; Gharibo, Christopher
2005 May-Jun;6(3):266-268, Pain medicine
Phantom limb pain has been well described in the literature. However, new-onset lumbar radicular pain superimposed on baseline lower extremity phantom pain is a clinical scenario that can be challenging to recognize. Furthermore, literature on recognition and treatment of phantom radiculopathy is all but lacking. We present a patient who experienced new-onset lumbar radiculopathy superimposed on her phantom pain that was successfully treated with fluoroscopic interlaminar and transforaminal epidural steroid injections
— id: 59240, year: 2005, vol: 6, page: 266, stat: Journal Article,

Resident and fellowship guidelines: educational guidelines for resident training in spinal surgery
Herkowitz HN; Connolly PJ; Gundry CR; Varlotta GP; Zdeblick TA; Truumees E
2000 Oct 15;25(20):2703-2707, Spine
— id: 35965, year: 2000, vol: 25, page: 2703, stat: Journal Article,

Professional roller hockey injuries
Varlotta GP; Lager SL; Nicholas S; Browne M; Schlifstein T
2000 Jan;10(1):29-33, Clinical journal of sport medicine
OBJECTIVE: To study the incidence and types of injuries sustained by professional roller hockey players in practices and games, and to compare these statistics with those from ice hockey. DESIGN: This injury survey used a strict definition of injury, standardized reporting strategies, and diagnosis by a team physician as standards by which to analyze the characteristics of roller hockey injuries. SETTING: The injuries were recorded after the players had been examined by a team physician at the game or practice site or in the physician's office. PARTICIPANTS: During three seasons for one roller hockey team and one season for another team, an average of 22 players per team participated in the study. Due to personnel changes, the team rosters were modified between seasons. Each player injury was included in the study. An injury was defined as any physical impairment caused during a practice or game that eliminated the player from that practice or game or the next day's practice session or contest, or any physical ailment that necessitated a physical examination by the team physicians. MAIN OUTCOME MEASURE: Injury data were categorized and injury rates were calculated. RESULTS: 122 injuries were recorded during four professional roller hockey seasons, resulting in an overall participation injury rate of 14.4 per 1,000 player hours. The game injury rate was 304.9 per 1,000 player hours. The players were 105.1 times more likely to be injured during a game than during practice. Preseason practices produced 4.5 times more injuries than regular season practices. In comparison, sample data from the only other published study of roller hockey injuries and from several studies of ice hockey have indicated game injury rates of 139.0 (roller hockey), 119.0, 96.1, 78.4, 78.8, and 66.0 per 1,000 player hours, respectively. CONCLUSION: Results of this study demonstrate that roller hockey produces a higher rate of both contact and noncontact injuries than ice hockey; this contradicts the findings of the only other published research study on injuries in roller versus ice hockey. This increased incidence of injury may be due in part to the differences in surfaces, and can prove hazardous to even the recreational roller hockey player or in-line skater
— id: 11816, year: 2000, vol: 10, page: 29, stat: Journal Article,

CATASTROPHIC CENTRAL-NERVOUS-SYSTEM DYSFUNCTION DURING METHYLPREDNISOLONE INJECTION FOR REFRACTORY PAIN SYNDROMES - REPORT OF 2 CASES
SILLER, KA; PANASCI, D; GEOCADIN, R; NELSON, J; GRIESZ, M; VARLOTTA, G
1995 AUG ;38(2):297-298, Annals of neurology
— id: 63774, year: 1995, vol: 38, page: 297, stat: Journal Article,

Electrodiagnostic testing of the spine
Varlotta GP; Vlattas J
1995 ;6(2):76-83, Current opinion in orthopaedics
— id: 8110, year: 1995, vol: 6, page: 76, stat: Journal Article,

Physical therapy, exercise, and manipulation in disorders of the lumbar spine
Varlotta GP; Vlattas J
1995 ;6(2):69-75, Current opinion in orthopaedics
— id: 8111, year: 1995, vol: 6, page: 69, stat: Journal Article,

Familial predisposition for herniation of a lumbar disc in patients who are less than twenty-one years old
Varlotta GP; Brown MD; Kelsey JL; Golden AL
1991 Jan;73(1):124-128, Journal of bone & joint surgery (American volume)
The parents of sixty-three patients who were less than twenty-one years old and who had operatively confirmed herniation of a lumbar disc were interviewed regarding a history of sever back pain, sciatica, and herniated disc, to determine whether aggregation of herniation of a lumbar disc occurs in families of patients in this young age-group. The parents of sixty-three additional patients who had a non-spinal orthopaedic diagnosis (control group) were matched for age and sex with the study group and were given the same interview. Of the patients who had herniation of a lumbar disc and were less than twenty-one years old, 32 per cent had a positive family history for that lesion compared with 7 per cent of the control group. The relative risk of development of herniation of a lumbar disc before the age of twenty-one years is estimated to be approximately five times greater in patients who have a positive family history. The results indicate a familial basis for herniation of a lumbar disc in patients who are less than twenty-one years old
— id: 35966, year: 1991, vol: 73, page: 124, stat: Journal Article,