Insufficient Clarity of Statement 6 in the Consensus Opinions to Prevent Neurologic Complications after Epidural Steroid Injections.

To the Editor: I read with interest the consensus opinions to prevent neurologic complications after epidural steroid injections in the May 2015 issue.1 The working group deserves the thanks of practitioners of interventional pain medicine. The statements serve to direct cervicothoracic spine.3 Furthermore, the lateral view did not provide consistent location of the needle tip in the epidural space with respect to bony landmarks.3 These limitations of the lateral view could account for some cases of spinal cord injury despite the use of fluoroscopy. In contrast to this, the CLO view provided crisp visualization of the needle tip and less variability in needle tip location when visualized at an angle of 50 degrees. Based on this, we propose that the preferred use of the CLO view for depth of insertion during interlaminar epidural access has the potential of reducing complications related to direct spinal cord injury. This is likely to be especially true in cases where the needle tip is not well visualized in the lateral view. Correct use of the CLO view as well as the pitfalls of the lateral view should be taught routinely in fellowships and in society educational workshops to promote the safe access to the epidural space.