Truly a critical review: root cause analysis of paraplegia following transforaminal epidural steroid injections: "unsafe" triangle.

We read with great interest the article by Glaser and Shah titled “Root Cause Analysis of Paraplegia Following Transforaminal Epidural Steroid Injections: The Unsafe Triangle (Pain Physician 2010; 13:237-244). For years, the well known “safe triangle” (when performing transforaminal lumbar epidural steroid injection) has been taught and learned by hundreds of interventionists in International Spinal Interventional Society (ISIS) training courses, teaching seminars, books, journals, educational videos, as well as in pain fellowship programs. This technique is considered “bread and butter” of interventional pain management. As fellowship trained, board certified interventional pain specialists, we were more than stunned by what was presented in this perspective review. The faPain Physician: January/February 2011; 14:E69-E86