Search Our Scientific Publications & Authors

PM R 2018 Nov 19. Epub 2018 Nov 19.

Division of PM&R, Jordan-Young Institute, Virginia Beach, VA.

Arch Phys Med Rehabil 2019 Jan 28. Epub 2019 Jan 28.

School of Physical Therapy, Regis University, Denver, CO, USA; Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA; Rehabilitation Services, Concord Hospital, NH, USA.

Objective: To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in patients with lumbar spinal stenosis (LSS).

Design: Randomized clinical trial.

Setting: Orthopaedic spine clinics. Read More

J Back Musculoskelet Rehabil 2019 Jan 11. Epub 2019 Jan 11.

Department of Orthopaedic Surgery-Spine Center, University of California, San Francisco, CA, USA.

Background: Non-surgical treatment is the primary approach to degenerative conditions of the lumbar spine and may involve multiple modalities. There is little literature to guide an evidence-based approach to care.

Objective: To determine the effectiveness of CNT (comprehensive non-surgical treatment) in patients with degenerative spondylolisthesis (DS) and spondylolytic spondylolisthesis (SS), and to identify predictor variables for success of CNT in avoiding surgery. Read More

Turk Neurosurg 2018 Oct 8. Epub 2018 Oct 8.

BALIKESIR UNIVERSITY.

Aim: Lumbar disc herniation is a common disease and can cause back pain and radicular pain. Some cases require surgical intervention for persistent severe pain. In other cases, transforaminal epidural steroid injection is the treatment of choice. Read More

J Pain Res 2019 31;12:171-177. Epub 2018 Dec 31.

Department of Anesthesiology, Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China,

Background: Cervical transforaminal epidural steroid injection (CTFESI) is used to provide pain relief and restore function in patients with cervical radiculopathy. Traditionally, it is performed under the guidance of fluoroscopy or computed tomography. Here, we introduce a novel technique - ultrasound-guided CTFESI - with which operators can easily distinguish the close soft tissue (nerve, vessels) around the cervical foramina to avoid intravascular injection during the procedure. Read More

Reg Anesth Pain Med 2019 Jan;44(1):118-121

Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

In patients with a history of a hypersensitivity reaction to iodinated contrast medium, iodinated contrast medium is avoided, antihistamine and steroid premedication are given, or a gadolinium-based contrast agent is employed. Six patients with a history of a hypersensitivity reaction to iodinated contrast medium and who were not premedicated had an unintentional injection of iodinated contrast. None of the patients developed a moderate or severe reaction. Read More

Radiology 2019 Jan 8:181224. Epub 2019 Jan 8.

From the Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland (T.J.D., C.K.P., S.B., R.S., C.W.A.P.); Division of Medical Physics, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland (K.G.Z.); and Faculty of Medicine, University of Zurich, Zurich, Switzerland (T.J.D., C.K.P., K.G.Z., S.B., R.S., C.W.A.P.).

Purpose To compare the radiation exposure for participants and interventionalists as well as participant outcomes between fluoroscopy-guided versus CT-guided lumbar spinal injections. Materials and Methods This prospective, nonrandomized observational study included 1446 participants (mean age, 60.6 years; range, 18-91 years) who received transforaminal epidural injections or facet joint injections under fluoroscopic or CT guidance between October 2009 and April 2016. Read More

Pain Ther 2019 Jan 8. Epub 2019 Jan 8.

Pain Clinic and Palliative Care Unit, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, 10131, Turin, Italy.

Introduction: Acute lumbosacral radicular syndrome is often a medical disorder of difficult management. Epidural steroid injection is a useful approach for the herniated disc and radiculitis. The transforaminal approach is usually considered more effective and target-specific, but it can be associated with permanent lower extremity paralysis. Read More

Ann Rehabil Med 2018 Dec 28;42(6):814-821. Epub 2018 Dec 28.

Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.

Objective: To suggest rotation angles of fluoroscopy that can bypass the carotid sheath according to vertebral levels for cervical transforaminal epidural steroid injection (TFESI).

Methods: Patients who underwent cervical spine magnetic resonance imaging (MRI) from January 2009 to October 2017 were analyzed. In axial sections of cervical spine MRI, three angles to the vertical line (α, angle not to insult carotid sheath; β, angle for the conventional TFESI; γ, angle not to penetrate carotid artery) were measured. Read More

Skeletal Radiol 2019 Jan 2. Epub 2019 Jan 2.

Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca Fevzi Çakmak Mahallesi Pendik, 34906, Istanbul, Turkey.

Objective: To examine the impact of the presence of facet tropism on the results of transforaminal epidural steroid injection for unilateral radicular pain induced by lumbar disc herniation.

Materials And Methods: We included 112 patients diagnosed with unilateral, single-level lumbar disc herniation-induced radicular pain. Injection was planned at relevant levels. Read More

World Neurosurg 2018 Dec 24. Epub 2018 Dec 24.

Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey; Department of Physical Medicine and Rehabilitation, Section of Pain Medicine, Marmara University School of Medicine, Istanbul, Turkey.

Objective: Transforaminal epidural steroid injections (TFESIs) have been increasingly used in the treatment of lumbar radicular pain resistant to conservative modalities. Although different steroids can be used at different doses, the minimally effective steroid dose should be used to reduce side effects. The present retrospective study examined and compared the efficacy of 40 mg and 80 mg of methylprednisolone in TFESIs. Read More

J Spine Surg 2018 Sep;4(3):529-533

Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL, USA.

Background: To determine if the timing of a lumbar epidural steroid injection (LESI) effects rates of post-operative infection in patients receiving a non-fusion lumbar decompression (LDC) due to degenerative disc disease (DDD). Lumbar pain due to DDD can frequently be temporized or definitively treated with epidural injections. While there is ample literature regarding the infection risks associated with corticosteroid injections prior to hip/knee replacements, there are few studies relating to the spine. Read More

Front Cell Neurosci 2018 22;12:453. Epub 2018 Nov 22.

Pain Research Center, Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States.

Low back pain, a leading cause of disability, is commonly treated by epidural steroid injections that target the anti-inflammatory glucocorticoid receptor (GR). However, their efficacy has been controversial. All currently used epidural steroids also activate the pro-inflammatory mineralocorticoid receptor (MR) with significant potency. Read More

J Pain Res 2018 21;11:2961-2967. Epub 2018 Nov 21.

Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea,

Background: A caudal epidural steroid injection (CESI) is a commonly used method to improve symptoms of lumbosacral pain. We compared the achievement of successful epidurograms and patient-reported clinical outcomes following different needle-insertion depths during CESI.

Methods: For the conventional method group, the needle was advanced into the sacral canal. Read More

J Ultrasound 2018 Dec 5. Epub 2018 Dec 5.

Department of Physical Medicine and Rehabilitation, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye 7 dong 761-7, Nowon-gu, 139-707, Seoul, South Korea.

Purpose: Recent studies have compared the therapeutic efficacy and safety of the procedure using ultrasound and fluoroscopy. However, there are no published studies comparing the therapeutic efficacy and safety of fluoroscopy (FL)-guided cervical interlaminar epidural steroid injection (CIESI) with that of ultrasound (US)-guided selective nerve root block (SNRB). This study aimed to compare the mid-term effects and advantages of US-guided SNRB with FL-guided CIESI for radicular pain in the lower cervical spine through assessment of pain relief and functional improvement. Read More

Z Orthop Unfall 2018 Nov 27. Epub 2018 Nov 27.

Department Wirbelsäule, Sportklinik Stuttgart GmbH.

Background: Many members of the adult population suffer acute low back pain at some stage in life. A specific cause is found in only a rather small number of these patients. Some of the patients develop chronic low back pain and this is a major source of disability. Read More

Front Pharmacol 2018 1;9:1229. Epub 2018 Nov 1.

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, United States.

Corticosteroids have played a standard role in the multimodal pain management in the treatment of chronic spinal pain (cervical and lumbar) and osteoarthritis pain over the past three decades. In this review we discuss different types of injectable steroids that are mainly used for injection into the epidural space (for the treatment of radicular back and neck pain), and as intra-articular injections for different types of osteoarthritis related pain conditions. Furthermore, we discuss different approaches taken for epidural corticosteroid injections and spinal surgical rates when injections fail to resolve painful conditions, as well as the possibility of using local anesthetics alone for neuraxial injections, instead of in combination with corticosteroids. Read More

Saudi J Anaesth 2018 Oct-Dec;12(4):599-605

Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Background: Low back pain (LBP) is one of the most common musculoskeletal abnormalities. Epidural corticosteroid injections (ESIs) have been used long time ago for treatment of lumbar radiculopathy or discogenic back pain in case of failed medical and conservative management. Different techniques for ESIs include the interlaminar, the caudal, and the transforaminal approaches. Read More

Singapore Med J 2018 Nov 7. Epub 2018 Nov 7.

Pain Management Centre, Singapore General Hospital, Singapore.

Introduction: Epidural steroid injections are an integral part of nonsurgical management of radicular pain from lumbar spine disorders. We studied the effect of dexamethasone 8 mg epidural injections on the hypothalamic-pituitary-adrenal axis and serum glucose control of Asian patients.

Methods: 18 patients were recruited: six diabetics and 12 non-diabetics. Read More

Semin Intervent Radiol 2018 Oct 5;35(4):290-298. Epub 2018 Nov 5.

Chief of Minimal Invasive Spinal Treatment Unit.

Spinal pain is a common condition leading to significant disability and high cost. Spinal injections have been demonstrated to be effective short-term treatments with cost-utility superior to numerous other treatments, including surgical procedures. Appropriate patient selection-based on clinical and imaging finding-and the use of image guidance associated with technical precautions improve the safety and effectiveness of spinal injection and overall patient outcomes. Read More

Pain Pract 2018 Oct 27. Epub 2018 Oct 27.

Evidence-Based Pain Management Research and Education, Cleveland Clinic, Cleveland, Ohio, U.S.A.

Background: Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. Read More

Pain Med 2018 Dec;19(12):2371-2376

Departments of Orthopaedic Surgery.

Objective: To assess the effect depression has on outcomes after cervical epidural steroid injections (CESIs).

Design: Retrospective review of a prospectively collected database.

Setting: Single institution tertiary care center. Read More

Int Med Case Rep J 2018 11;11:263-264. Epub 2018 Oct 11.

Department of Anesthesiology, Mayo Clinic Hospital, Phoenix, AZ, USA,

Singultus (hiccups lasting longer than 48 hours) is a described complication following epidural steroid injections, sacroiliac joint injections, and facet joint injections. The underlying etiology is not completely understood, but it is a condition that can be distressing to patients. Our case presentation involves a 62-year-old male presenting for cervical epidural steroid injection. Read More

Medicine (Baltimore) 2018 Oct;97(41):e12791

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

A previous study showed that transforaminal balloon adhesiolysis via the safe triangle was effective in lumbar spinal stenosis. However, retrodiscal pathology is difficult to treat with this method. Therefore we attempted retrodiscal balloon adhesiolysis via Kambin's triangle. Read More

Korean J Pain 2018 Oct 1;31(4):305-306. Epub 2018 Oct 1.

Department of Surgery, Anesthesia and Intensive Care Section, G.B. Morgagni-Pierantoni Hospital, Forlì, Italy.

Korean J Pain 2018 Oct 1;31(4):277-288. Epub 2018 Oct 1.

Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Background: Neck and back pain are leading sources of disability placing substantial burden on health care systems. Surgical interventions in managing chronic neck pain secondary to various disorders continue to increase. Even though surgical interventions are effective, a significant proportion of patients continue to have symptomatology and develop cervical post-surgery syndrome. Read More

Chiropr Man Therap 2018 2;26:33. Epub 2018 Oct 2.

Veterans Affairs Saint Louis Health Care System, St. Louis, MO USA.

Background: Spinal epidural lipomatosis is an uncommon source of neurogenic claudication. We present two cases of spinal epidural lipomatosis as it relates to diagnosis, management, and a possible association with common medical intervention.

Case Presentation: Case 1: 63-year old male patient presented with neurogenic claudication symptoms, but without evidence of bony central canal stenosis on lumbar computed tomography. Read More

Bone Joint J 2018 Oct;100-B(10):1364-1371

Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.

Aims: The aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation.

Patients And Methods: A cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Read More

Clin Spine Surg 2018 Oct 3. Epub 2018 Oct 3.

Carl R. Darnall Army Medical Center, Fort Hood, TX.

Pain Physician 2018 09;21(5):E493-E499

Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, NY.

Background: Previous surveys have identified variations in practice patterns related to epidural steroid injections. Since then, the United States Food and Drug Administration (FDA) has required the addition of drug warning labels for injectable corticosteroids. Updated evidence, as well as scrutiny from regulatory agencies, may affect practice patterns. Read More

Pain Physician 2018 09;21(5):433-448

Department of Physical and Rehabilitation Medicine, Veterans Medical Center, Seoul, South Korea.

Background: Epidural injection (EI) is used to treat back or radicular pain from lumbosacral disc herniation (LDH). Although several reports have stated that the transforaminal approach in EI (TFEI) has an advantage in target specificity and yields better clinical efficacy than the interlaminar approach in EI (ILEI), other studies have indicated that the clinical efficacy of ILEI was not inferior to that of TFEI and that ILEI also has the ability to spread medication into the ventral space to a degree similar to that of TFEI. There has been controversy about whether TFEI is superior to ILEI in clinical efficacy. Read More

Pain Manag 2018 Sep 3;8(5):321-326. Epub 2018 Oct 3.

Department of Physical Medicine & Rehabilitation, Gulhane School of Medicine, University of Health Science, Ankara 06100, Turkey.

Aim: To investigate the long-term effect of fluoroscopy guided cervical transforaminal epidural steroid injection on neck pain radiating to the arm due to cervical disc herniation.

Materials & Methods: 64 patients (26 women [40.6%], 38 men [59. Read More

Int J Spine Surg 2018 Apr 3;12(2):139-148. Epub 2018 Aug 3.

Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio.

Background: Lumbar degenerative conditions are an extremely common set of diagnoses with a large spectrum of treatment options. Epidural steroid injections (ESI) are widely used but have come under increased scrutiny as we move toward a value-based model of health care. We assessed current utilization of epidural steroid injections, changes in utilization over time, and the influence of payer type and geographic region within the United States on their utilization. Read More

Medicine (Baltimore) 2018 Sep;97(37):e12389

Touro College of Osteopathic Medicine, New York.

Rationale: Perineural cysts, commonly referred to as Tarlov cysts, are cerebrospinal fluid-filled dilations between the perineurium and endoneurium typically arising at the junction of posterior and dorsal root ganglia in the neural foramina. This anatomical location is in close proximity to usual needle trajectory during performing transforaminal epidural injection, and therefore presents a potential risk of dural puncture and associated complications.

Patient Concerns: Severe lower extremity pain interfering with activities of daily living. Read More

Acta Neurochir (Wien) 2018 Nov 10;160(11):2225-2227. Epub 2018 Sep 10.

Department of Neurosurgery, The George Washington University, 2150 Pennsylvania Avenue, NW, Suite 7-412, Washington, DC, 20037, USA.

Diabetic lumbosacral radiculoplexus neuropathy is often confused with radiculopathy in the context of spinal degenerative disc disease including spinal stenosis. Accuracy in diagnosis may prevent unnecessary interventional procedures including selective nerve root blocks or epidural steroid injections or even surgery in selected cases. Our patient with known diabetes and lumbar disc disease presented with acute onset of pain in L5-S1 distribution of the left lower extremity. Read More

Medicine (Baltimore) 2018 Sep;97(36):e12215

Rationale: False localizing sign means that the lesion, which is the cause of the symptom, is remote or distant from the anatomical site predicted by neurological examination. This concept contradicts the classical clinicoanatomical correlation paradigm underlying neurological examinations.

Patient Concerns: A 54-year-old man consulted for the right sciatica-like leg pain that had aggravated 1 year ago. Read More

Reg Anesth Pain Med 2018 Oct;43(7):789-794

Millennium Pain Center, Bloomington, IL.

Background And Objectives: This study evaluated the long-term durability of the minimally invasive lumbar decompression (MILD) procedure in terms of functional improvement and pain reduction for patients with lumbar spinal stenosis and neurogenic claudication due to hypertrophic ligamentum flavum. This is a report of 2-year follow-up for MILD study patients.

Methods: This prospective, multicenter, randomized controlled clinical study compared outcomes for 143 patients treated with MILD versus 131 treated with epidural steroid injections. Read More

Trials 2018 Sep 5;19(1):475. Epub 2018 Sep 5.

Clinical Trials Research Centre, University of Liverpool, Liverpool, L12 2AP, UK.

Background: Sciatica is a common condition reported to affect over 3% of the UK population at any time and is often caused by a prolapsed intervertebral disc (PID). Although the duration and severity of symptoms can vary, pain persisting beyond 6 weeks is unlikely to recover spontaneously and may require investigation and treatment. Currently, there is no specific care pathway for sciatica in the National Health Service (NHS), and no direct comparison exists between surgical microdiscectomy and transforaminal epidural steroid injection (TFESI). Read More

World Neurosurg 2018 Dec 27;120:e580-e592. Epub 2018 Aug 27.

Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. Electronic address:

Objective: The purpose of the present study was to assess for gender-based differences in the usage and cost of maximal nonoperative therapy before spinal fusion surgery in patients with symptomatic lumbar stenosis or spondylolisthesis.

Methods: A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index lumbar decompression and fusion procedures from 2007 to 2016. This database consists of 20. Read More

Surg Neurol Int 2018 10;9:159. Epub 2018 Aug 10.

Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.

Background: Chronic low back pain (LBP) is highly prevalent and costly in our society. The use of epidural steroid injections (ESIs) for the treatment of radicular LBP is very widespread and continues to rise. The most popular injection is the lumbar/sacral transforaminal epidural steroid injection (TFESI). Read More

Am J Phys Med Rehabil 2018 Oct 5. Epub 2018 Oct 5.

Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.

Objectives: To evaluate the influence of the depth of local anesthesia application on procedural pain during lumbar transforaminal epidural steroid injection (TFESI).

Design: Sixty-eight patients were enrolled who were scheduled for single-level, unilateral fluoroscopically-guided lumbar TFESI. Patients were randomly allocated to receive either subcutaneous local anesthesia (group S) or deep local anesthesia (group D) for TFESI. Read More

Clin Neurol Neurosurg 2018 Oct 24;173:38-45. Epub 2018 Jul 24.

Center for Advanced Spine Care of Southern Arizona, United States; Surgical Institute of Tucson, United States. Electronic address:

Objective: To analyze the positive predictive value of diagnostic 1% lidocaine containing transforaminal epidural steroid injections (TESI) for successful outcome after outpatient endoscopic decompression for lumbar foraminal and lateral recess stenosis.

Patients And Methods: A retrospective study of 1839 consecutive patients with an average mean follow-up of 33 months that underwent endoscopic transforaminal decompression at 2076 lumbar levels was conducted. The sensitivity, specificity, and positive predictive value of lidocaine containing diagnostic TESI at the intended surgical level were calculated based on the recorded frequency of >50% VAS score reduction, intraoperatively visualized stenosis, and clinical outcomes assessed by Macnab criteria and VAS reduction. Read More

Br J Hosp Med (Lond) 2018 Aug;79(8):465-467

Consultant Radiologist, Department of Radiology, Guy's and St Thomas' Foundation Trust, London.

Background: Computed tomography-guided steroid injection is a well-recognized, conservative treatment of localized spinal pain as a result of facet arthropathy and radiculopathy secondary to nerve root compression. An extremely rare complication is the development of an epidural haematoma with potential to cause permanent neurological damage, so anticoagulation at the time of procedure is contraindicated. Routinely injections are performed as an outpatient requiring the referring physician to implement a peri-procedural anticoagulation plan. Read More

World Neurosurg 2018 Nov 27;119:e244-e249. Epub 2018 Jul 27.

Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Electronic address:

Objective: To assess postoperative outcomes and complications after percutaneous endoscopic lumbar discectomy (PELD) with or without epidural steroids (ES) administration in lumbar disc herniation.

Methods: In a double-blind randomized, placebo-controlled trial at Ramathibodi Hospital, Mahidol University, from May 2014 to May 2015, 30 patients were randomly allocated to receive ES or placebo (saline) after PELD. The primary outcome was 24-hour morphine consumption. Read More

Pain Physician 2018 07;21(4):E435-E447

Seoul National University College of Medicine, Seoul, Koreaand Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine.

Background: Glucocorticoids adversely affect bone mineral density (BMD) and increase the risk of fracture. Yet, the cause-and-effect relationship between epidural steroid injection (ESI) and BMD has not been thoroughly investigated, and available results are inconsistent. This is probably a consequence of differences in the dose of steroids and follow-up duration. Read More

Pain Physician 2018 07;21(4):373-382

Department of Anesthesiology Nara Medical University, Nara, Japan.

Background: The acute phase of shingles is characterized by severe pain, and one of the complications of shingles known as postherpetic neuralgia (PHN) is associated with prolonged pain. Although factors predicting the development of PHN, as well as its preventative measures, have been investigated, there is no single treatment effective for PHN. Some studies showed effectiveness of epidural injection to alleviate pain associated with acute-phase shingles. Read More

Skeletal Radiol 2018 Dec 22;47(12):1625-1633. Epub 2018 Jul 22.

Centre d'imagerie ostéo-articulaire, Clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700, Mérignac, France.

Introduction: The treatment of persistent cervical radicular pain (CRP) by CT-guided epidural steroid injections (CTESI) by a transforaminal anterolateral (TFA) approach is associated with rare but serious complications. Two recently described transforaminal posterolateral (TFP) and transfacet indirect (TFT) approaches may be safer options, but have not been extensively evaluated. We compared the efficacy of three CTESI approaches (TFA, TFP, and TFT) in the treatment of persistent CRP (>6 weeks). Read More

J Clin Endocrinol Metab 2018 Sep;103(9):3405-3410

Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, New York, New York.

Context: Epidural steroid injections (ESIs) are a common, effective treatment of lumbar radiculopathy and sciatica. Although the negative skeletal effects of oral glucocorticoids are well established, little is known about the impact of ESI on bone quality.

Objective: To investigate the relationship between ESI exposure and volumetric bone mineral density (vBMD) at the lumbar spine (LS) using central quantitative CT. Read More

Spine J 2019 Feb 26;19(2):199-205. Epub 2018 Jun 26.

Stanford University School of Medicine, 450 Broadway St, Pavilion C, 4th Floor, Mail Code 6342, Redwood City, CA 94063, USA. Electronic address:

Background Context: Lumbosacral epidural steroid injections (ESIs) have increased dramatically despite a narrowing of the clinical indications for use. One potential indication is to avoid or delay surgery, yet little information exists regarding surgery rates after ESI.

Purpose: The purpose of this research was to determine the proportion of patients having surgery after lumbar ESI for disc herniation or stenosis and to identify the timing and factors associated with this progression. Read More