Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis
Authors: Laxmaiah Manchikanti, Alan David Kaye, Joshua A. Hirsch
Journal: Annals of Internal Medicine (2016)

Letters3 May 2016Epidural Corticosteroid Injections for Radiculopathy and Spinal StenosisLaxmaiah Manchikanti, MD, Alan David Kaye, MD, PhD, and Joshua A. Hirsch, MDLaxmaiah Manchikanti, MDFrom University of Louisville and Pain Management Center of Paducah, Louisville and Paducah, Kentucky; Louisiana State University School of Medicine, New Orleans, Louisiana; and Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts., Alan David Kaye, MD, PhDFrom University of Louisville and Pain Management Center of Paducah, Louisville and Paducah, Kentucky; Louisiana State University School of Medicine, New Orleans, Louisiana; and Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts., and Joshua A. Hirsch, MDFrom University of Louisville and Pain Management Center of Paducah, Louisville and Paducah, Kentucky; Louisiana State University School of Medicine, New Orleans, Louisiana; and Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-0566 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We are concerned that the recent systematic review by Chou and colleagues (1) will have far-reaching consequences on patients who might benefit from epidural corticosteroid injections for radiculopathy and spinal stenosis. The systematic review is similar to an earlier publication by Pinto and coworkers (2). The fundamental flaw of these articles is that the authors converted all active control trials to placebo controlled trials with unproven hypotheses that all therapeutic effects in the epidural space are secondary to steroids (1). In our opinion, this is a scientifically and clinically incorrect methodology. Systematic reviews have demonstrated the long-term ...References1. Chou R, Hashimoto R, Friedly J, Fu R, Bougatsos C, Dana T, et al. Epidural Corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Ann Intern Med. 2015;163:373-81. [PMID: 26302454]. doi:10.7326/M15-0934 LinkGoogle Scholar2. Pinto RZ, Maher CG, Ferreira ML, Hancock M, Oliveira VC, McLachlan AJ, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med. 2012;157:865-77. [PMID: 23362516] LinkGoogle Scholar3. Manchikanti L, Nampiaparampil DE, Manchikanti KN, Falco FJ, Singh V, Benyamin RM, et al. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: a systematic review of randomized controlled trials. Surg Neurol Int. 2015;6:S194-235. [PMID: 26005584] doi:10.4103/2152-7806.156598 CrossrefMedlineGoogle Scholar4. Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA. Do epidural injections provide short- and long-term relief for lumbar disc herniation? A systematic review. Clin Orthop Relat Res. 2015;473:1940-56. [PMID: 24515404] doi:10.1007/s11999-014-3490-4 CrossrefMedlineGoogle Scholar5. Manchikanti L, Kaye AD, Manchikanti K, Boswell M, Pampati V, Hirsch J. Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review. Anesth Pain Med. 2015;5:e23139. [PMID: 25789241] doi:10.5812/aapm.23139 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Louisville and Pain Management Center of Paducah, Louisville and Paducah, Kentucky; Louisiana State University School of Medicine, New Orleans, Louisiana; and Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L15-0566.This article was published at www.annals.org on 16 February 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEpidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis Roger Chou , Robin Hashimoto , Janna Friedly , Rongwei Fu , Christina Bougatsos , Tracy Dana , Sean D. Sullivan , and Jeffrey Jarvik Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis Denis F. Darko Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis Timothy P. Maus , Belinda S. Duszynski , and Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis Irbaz Bin Riaz and Robert G. Badgett Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis Roger Chou , Robin Hashimoto , and Janna Friedly Metrics 3 May 2016Volume 164, Issue 9Page: 633KeywordsDisclosureHealth care quality assessmentHospitalizationsMilkNSAIDsOpioidsStenosisSteroidsSurgerySystematic reviews ePublished: 3 May 2016 Issue Published: 3 May 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...