Point/Counterpoint
Interpreting Reviews and Guidelines: The Case of Lumbar Epidural Steroid Injections
Venu Akuthota MD,
Charles Argoff MD,
William C. Watters III MD,
Corresponding Author
Venu Akuthota MD
Guest Discussant
Associate Professor and Pain Fellowship Director, Department of Physical Medicine and Rehabilitation, University of Colorado Denver School of Medicine, PO Box 6511, Mail Stop F-493, Aurora, CO 80045
Disclosure: nothing to discloseAddress correspondence to: V.A.Search for more papers by this authorCharles Argoff MD
Guest Discussant
Professor of Neurology, Albany Medical College, Director Comprehensive Pain Program, Albany Medical Center, Albany, NY
Disclosure: nothing to discloseSearch for more papers by this authorWilliam C. Watters III MD
Commentary
Clinical Assistant Professor of Orthopedics, Baylor College of Medicine, and University of Texas Medical Branch, Houston, TX
Disclosure: nothing to discloseSearch for more papers by this authorVenu Akuthota MD,
Charles Argoff MD,
William C. Watters III MD,
Corresponding Author
Venu Akuthota MD
Guest Discussant
Associate Professor and Pain Fellowship Director, Department of Physical Medicine and Rehabilitation, University of Colorado Denver School of Medicine, PO Box 6511, Mail Stop F-493, Aurora, CO 80045
Disclosure: nothing to discloseAddress correspondence to: V.A.Search for more papers by this authorCharles Argoff MD
Guest Discussant
Professor of Neurology, Albany Medical College, Director Comprehensive Pain Program, Albany Medical Center, Albany, NY
Disclosure: nothing to discloseSearch for more papers by this authorWilliam C. Watters III MD
Commentary
Clinical Assistant Professor of Orthopedics, Baylor College of Medicine, and University of Texas Medical Branch, Houston, TX
Disclosure: nothing to discloseSearch for more papers by this author
Dr. Argoff Responds
- 1C. Armon, C.E. Argoff, J. Samuels, M. Backonja. Assessment: use of epidural steroid injections to treat radicular lumbosacral pain: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2007; 68: 723–729.
- 2S. Novak, W.C. Nemeth. The basis for recommending repeat epidural steroid injections for radicular low back pain: a literature review. Arch Phys Med Rehabil. 2008; 89: 543–552.
- 3C. Price, N. Arden, L. Coglan, P. Rogers. Cost-effectiveness and safety of epidural steroids in the management of sciatica. Health Technol Assess. 2005; 9: 1–58.
Dr. Akuthota Responds
- 1 National Clearinghouse for guidelineshttp://www.guideline.gov/search/searchresults.aspx?Type=3&txtSearch=back+pain&num=20, Accessed October 23, 2008.
- 2C. Armon, C.E. Argoff, J. Samuels, M. Backonja. Assessment: use of epidural steroid injections to treat radicular lumbosacral pain: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2007; 68: 723–729.
- 3 American College of Occupational and Environmental Medicine (ACOEM) Low Back Disorders. Occupational medicine practice guidelines: evaluation and management of common health problems and functional recovery of workers. 2nd ed. Beverly Farms, Elk Grove Village, IL: OEM Press. 2007.
- 4T.F. Dilke, H.C. Burry, R. Grahame. Extradural corticosteroid injection in the management of lumbar nerve root compression. Br Med J. 1973; 2: 635–637.
- 5J. Wilson-MacDonald, G. Burt, D. Griffin, C. Glynn. Epidural steroid injection for nerve root compression. A randomised, controlled trial. J Bone Joint Surg Br. 2005; 87: 352–355.
- 6G.R. Buttermann. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study. J Bone Joint Surg Am. 2004; 86-A: 670–679.
- 7V.B. Vad, A.L. Bhat, G.E. Lutz, F. Cammisa. Transforaminal epidural steroid injections in lumbosacral radiculopathy: prospective randomized study. Spine. 2002; 27: 11–16.
- 8J.P. Valat, B. Giraudeau, S. Rozenberg, et al. Epidural corticosteroid injections for sciatica: a randomized, double blind, controlled clinical trial. Ann Rheum Dis. 2003; 62: 639–643.
- 9L. Manchikanti, V. Singh, R. Derby, et al. Reassessment of evidence synthesis of occupational medicine practice guidelines for interventional pain management. Pain Physician. 2008; 11: 393–482.
- 10K.D. Riew, Y. Yin, L. Gilula, et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am. 2000; 82-A: 1589–1593.
- 11 North American Spine Society (NASS). Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis. 2007, http://www.spine.org/Documents/NASSCG_Stenosis.pdf, Accessed October 23, 2008.
- 12Bogduk N. “PASSOR: Lumbar Spine Interventional Management,” September 29, 2007, lecture at the American Academy of Physical Medicine and Rehabilitation 68th Annual Assembly, Boston, MA.
- 13S. Carette, R. Leclaire, S. Marcoux, F. Morin, G.A. Blaise, A. St-Pierre, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med. 1997; 336: 1634–1640.
- 14J.M. Cuckler, P.A. Bernini, S.W. Wiesel, R.E. BoothJr, R.H. Rothman, G.T. Pickens. The use of epidural steroids in the treatment of lumbar radicular pain. J Bone Joint Surg Am. 1985; 67: 63–66.
- 15K. Bush, S. Hillier. A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica. Spine. 1991; 16: 572–575.
- 16M. Buchner, F. Zeifang, D.R. Brocai, M. Schiltenwolf. Epidural corticosteroid injection in the conservative management of sciatica. Clin Orthop. 2000; 375: 149–156.
- 17M. Whitworth, J. de Cordoba. Is it finally time to abandon the use of blind interlaminar epidural steroid injections?. Intervent Spine. 2008; 6: 16–29.
- 18J. Karppinen, A. Malmivaara, M. Kurunlahti, et al. Periradicular infiltration for sciatica: a randomized controlled trial. Spine. 2001; 26: 1059–1067.
- 19J. Karppinen, A. Ohinmaa, A. Malmivaara, et al. Cost effectiveness of periradicular infiltration for sciatica. Spine. 2001; 26: 2587–2595.
- 20G.E. Lutz, V.B. Vad, R.J. Wisneski. Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil. 1998; 79: 1362–1366.
- 21Weinstein JN, Bronner KK, Morgan TS, Wennberg JE. “Trends and geographic variation in major surgery for degenerative diseases of the hip, knee and spine.” Health Affairs Web Exclusive, VAR-81, 2004.
Commentary by Dr. William Watters
- 1C. Armon, C.E. Argoff, J. Samuals, M. Backonja. Assessment: use of epidural steroid injections to treat radicular lumbosacral pain: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2007; 68: 723–729.
- 2G.R. Butterman. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study. J Bone Joint Surg AM. 2004; 86-A: 670–679.
- 3L. Manchikanti, V. Singh, R. Derby, et al. Reassessment of evidence synthesis of occupational medicine practice guidelines for interventional pain management. Pain Physician. 2008; 11: 393–482.
- 4T.M. Shaneyfelt, R.M. Centor. Reassessment of clinical practice guidelines: go gently into the good night. JAMA. 2009; 301: 868–869.
- 5M.B. McClellan, J.M. McGinnis, E.G. Nabel, L.M. Olsen. Evidence-based medicine and the changing nature of healthcare. Summary. Washington, DC: Institute of Medicine. 2008.
Citing Literature
