To the Editor: Derby et al (1) noted that in 2003 approximately half (14/29) of International Spinal Injection Society (ISIS) instructors and the majority (14/17) of poll respondents reported performing transforaminal epidural steroids injections. Do the authors have any data as to needle type (blunt vs sharp) used? If ISIS instructors persist in performing transforaminal injections with sharpt...

We read with great interest a recent study by Ghai et al (1) wherein they followed 56 out of 69 randomized patients for 12 months following parasagittal interlaminar (PIL) injection with local anesthetics (LA) alone or LA with steroid (LS). We agree with author’s choice of technique to achieve adequate and consistent ventral epidural spread of injectate. Parasagittal interlaminar epidural stero...

Meralgia paresthetica is a mononeuropathy which occurs as result of lateral femoral cutaneous nerve being under pressure at groin level; with numbness, pains and needles, and pain at external collateral and anterior thigh and inguinal region. Its treatment is conservative and surgical. In our study, we intended to present our clinical evaluation as result of transforaminal epidural steroid appl...

BACKGROUND The estimated prevalence of lumbar radiculopathy has been described as 9.8 per 1,000 cases of low back pain. There are various surgical and nonsurgical modalities for treating lumbar disc herniation or radicular pain, including epidural injections. Epidural injection administration routes include transforaminal, interlaminar, and caudal approaches. The transforaminal approach require...

I enjoyed reading the guidelines provided by the American Society of Interventional Pain Physicians (Pain Physician 2007; 10:7-111). The guidelines are extensive, informative, and practical. These continue to be an asset for practices in interventional pain management since 2005. However, I would like to point out an error. In the evidence section for transforaminal epidural steroid injections ...

Purpose. Intravascular injection rates are higher during traditional S1 transforaminal epidural steroid injection (TFESI) compared with lumbar transforaminal injection. We compared the incidences of intravascular injection between the medial and lateral approaches to the S1 foramen during S1 TFESI. Materials and Methods. A total of 139 patients underwent one or more TFESIs (170 total injections...

OBJECTIVE To compare the short-term effect and advantage of transforaminal epidural steroid injection (TFESI) performed using the Kambin's triangle and subpedicular approaches. METHOD Forty-two patients with radicular pain from lumbar spinal stenosis were enrolled. Subjects were randomly assigned to one of two groups. All procedures were performed using C-arm KMC 950. The frequency of complic...

Serious complications following cervical epidural steroid injection are rare. Subdural injection of local anesthetic and steroid represents a rare but potentially life threatening complication. A patient presented with left sided cervical pain radiating into the left upper extremity with motor deficit. MRI showed absent lordosis with a broad left paramedian disc-osteophyte complex impinging the...

BACKGROUND Management of low back pain after spinal surgeries is one of the most challenging problems in pain medicine. Transforaminal lumbar epidural steroid injection has been used with inconsistent response. Most patients require multiple and frequent injections due to high recurrence of back pain. OBJECTIVE To find out whether the addition of hyaluronidase to the epidural injectate affect...