Letter to the Editor: Comparison of efficacy between transforaminal epidural steroid injection technique without contrast versus with contrast in lumbar radiculopathy: a prospective longitudinal cohort study

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Asian Spine J. 2024;18(3):483-484

Publication date (electronic) : 2024 June 26

doi : https://doi.org/10.31616/asj.2024.0177.r1

Pain Management Section, Department of Physical Medicine and Rehabilitation, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

Corresponding author: Rekib Sacaklidir, Pain Management Section, Department of Physical Medicine and Rehabilitation, Sisli Hamidiye Etfal Training and Research Hospital, Huzur Mah. Cumhuriyet ve Demokrasi Cad. No:1 Sarıyer, İstanbul, Turkey Tel: +90-553-804-4082; Fax: +90-212-373-5252; E-mail: rakipsacakli@hotmail.com

Received 2024 April 30; Revised 2024 May 13; Accepted 2024 May 20.

Dear Editor,

We have just read the study titled “Comparison of the efficacy of transforaminal epidural steroid injection technique with and without contrast in lumbar radiculopathy: prospective longitudinal cohort study,” but we were surprised [1]. Since intravascular penetration is common during epidural steroid injection. Even though drawback technique, using real-time fluoroscopy with contrast agent is not possible to detect more than 30% of intravascular penetration [2,3]. You may get close to the nerve root or epidural area with the method that you describe, but how did you determine that there was no vascular penetration? To what extent does drawback technique protect you from spinal complications?

Serious complications due to particulate steroids have been reported in spinal procedures. Additionally, particulate steroids are recommended to be used only in selected situations [4]. Although you did not use contrast in the study and you used particulate steroids. Would not this pose a significant risk to patients?

Finally, while even minor complication rates are around 2% [5], you state that you have not seen any complications in your study. Could you consider this as biases?

To promote our understanding of your excellent research, we look forward to hearing from you regarding our submission. It will also be a good response for our colleagues who perform these procedures.

Notes

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

All the work for the preparation of this commentary was done by Rekib Sacaklidir.

References

1. Pholsawatchai W, Manakul P, Lertcheewanan W, Siribumrungwoung K, Suntharapa T, Arunakul R. Comparison of efficacy between transforaminal epidural steroid injection technique without contrast versus with contrast in lumbar radiculopathy: a prospective longitudinal cohort study. Asian Spine J 2023;17:1108–16.

2. Visnjevac O, Kim P, Farid-Davari S, Johnson P, Nader ND. Digital subtraction angiography versus real-time fluoroscopy for detection of intravascular penetration prior to epidural steroid injections: meta-analysis of prospective studies. Pain Physician 2015;18:29–36.

3. Sacaklidir R, Yilmaz H, Ozturk EC, Gunduz OH, Sencan S. Comparison of the use of peripheral nerve stimulator and quincke needle for lumbar transforaminal epidural steroid injections. Turk Neurosurg 2024;34:480–4.

4. Delaney FT, MacMahon PJ. An update on epidural steroid injections: is there still a role for particulate corticosteroids? Skeletal Radiol 2023;52:1863–71.

5. Sencan S, Sacaklidir R, Gunduz OH. The immediate adverse events of lumbar interventional pain procedures in 4,209 patients: an observational clinical study. Pain Med 2022;23:76–80.

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