Aim We further evaluated associations between steroid injections and osteoporotic fracture risk by analyzing the Medicare database and including large joint and transforaminal steroid injections; as well as osteoporotic hip and wrist fractures. A systemic effect would increase risk in all fracture locations regardless of injection site. A local effect would result in a disproportionate increase...

Although postherpetic neuralgia (PHN) is a common chronic pain syndrome, the pathophysiology of this disorder is not well known and management is often very difficult. N-Methyl-D-Aspartate (NMDA) receptor antagonists are known to be effective in PHN, and magnesium, a physiological blocker of NMDA receptors, is widely used to treat various chronic pain disorders. Here, we present a case of the P...

The transforaminal epidural injection (TFEI) has been preferred in many cases because it can deliver the injected dose of medication closer to the nerve root and better facilitate ventral epidural flow compared to other methods. However, in patients with deformities not demonstrated on fluoroscopic imaging, the needle may enter unwanted locations. We treated two cases of intradiscal injection o...

Transforaminal endoscopic disc removal in the L5-S1 motion segment of the lumbar spine creates a technical challenge due to anatomical reasons and individual variability. The majority of surgeons prefer a posterior classical or minimally invasive approach. There is only one foraminoplastic modification of the technique in the literature so far. In this paper we present a new technique with a fo...

Epidural fibrosis is a contributing factor to the persistent pain that is associated with failed back surgery syndrome (FBSS) and other pathophysiologies, particularly as it inhibits the passage of regional medications to areas responsible for pain. Therefore, effective mechanical detachment of epidural fibrosis can contribute to pain reduction and improve function in FBSS patients. In this rep...

To the Editor: In metaphorical terms, a problem arises when good apples are pooled with bad apples; they all get tarred with the same brush. This principle applies when all studies pertaining to spinal injections of steroids are pooled, as if they are all equal. Subsequently, the lay press publicizes sweeping conclusions such as “injecting any liquid, even plain saline solution, works just as w...

Fact: All particulate corticosteroid preparations have been implicated in rare cases of paraplegia, whereas no definitive evidence exists of paraplegia resulting from injection of non-particulate steroids. Studies directly comparing the effectiveness of particulate and non-particulate steroids largely show no differences between the two, with respect to relief of pain, restoration of function, ...