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CORRESPONDENCE
Year : 2011  |  Volume : 59  |  Issue : 6  |  Page : 948

The efficacy of transforaminal epidural steroid injections in lumbosacral radiculopathy: A commentary


Department of Orthopedics, Division of Spine and Musculoskeletal Oncology, Amrita Institute of Medical Sciences, Kochi, India

Date of Submission01-Nov-2011
Date of Decision01-Nov-2011
Date of Acceptance26-Nov-2011
Date of Web Publication2-Jan-2012

Correspondence Address:
R Krishnakumar
Department of Orthopedics, Division of Spine and Musculoskeletal Oncology, Amrita Institute of Medical Sciences, Kochi
India
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DOI: 10.4103/0028-3886.91404

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How to cite this article:
Krishnakumar R. The efficacy of transforaminal epidural steroid injections in lumbosacral radiculopathy: A commentary. Neurol India 2011;59:948

How to cite this URL:
Krishnakumar R. The efficacy of transforaminal epidural steroid injections in lumbosacral radiculopathy: A commentary. Neurol India [serial online] 2011 [cited 2014 Apr 19];59:948. Available from: http://www.neurologyindia.com/text.asp?2011/59/6/948/91404


Sir,

I read with interest this article by Roy et al.,[1] Authors describe the outcome of transforaminal epidural steroid injections (TFESI) in 30 patients with one-year follow-up and admit that they could not achieve 60% improvement in symptoms. It is interesting to note that 10 out of 30 patients had two-level disc involvements and it is unclear from the article whether the sciatica was unilateral or bilateral. Moreover, 9 out of 30 had repeated injections although the protocol of the study was to give a single injection. Although the study was well designed and carried out over a period of one year, the patient selection criteria could have been improved to include only single-level disc disease with unilateral symptoms lasting less than six months than to have a combination of single and double-level disc involvement with varied duration of symptoms. Therefore, non-adherence to stringent patient selection criteria probably resulted in less than expected outcome. In addition, authors state duration of symptoms < six months as a prognosticator for TFESI in sciatica but do not give sufficient information regarding the profile of those patients in terms of the number of discs involved. At the end of the study, the VAS (Visual Analog Scale) score was 4.2 suggesting that the patients still had uncomfortable pain.

Patient selection is a prime factor in the management of lumbar disc herniations. Spine Patient Outcomes Research Trial (SPORT) has conclusively proved that patients who underwent surgery for a lumbar disc herniation achieved greater improvement than nonoperatively treated patients in all primary and secondary outcomes except work status at the end of four years. [2]

The recent Michigan State University (MSU) classification of lumbar disc herniations suggests that Type 2-B and 2-AB herniations are better managed by surgery. [3] The future TFESI studies could incorporate MSU classification that may result in further understanding in the management of lumbar disc herniations.

 
 » References Top

1.Roy C, Chatterjee N, Patro SN, Chakraborty A, Vijay Kumar GR, Sengupta R. The efficacy of transforaminal epidural steroid injections in lumbosacral radiculopathy. Neurol India 2011;59:685-9.  Back to cited text no. 1
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2.Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, et al. Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila 1976) 2008;33:2789-800.  Back to cited text no. 2
    
3.Mysliwiec LW, Cholewicki J, Winkelpleck MD, Eis GP. MSU classification for herniated lumbar discs on MRI: Toward developing objective criteria for surgical selection. Eur Spine J 2010;19:1087-93.  Back to cited text no. 3
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Roy, C., Chatterjee, N., Satya, P.N., Chakraborty, A., Vijay Kumar, G.R., Sengupta, R.
Neurology India. 2011; 59(6): 948-949
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