A Response to Two Recent Reviews of Epidural Steroid Injections

Abstract

Dear Editor, We applaud MacVicar et al. on their excellent evidence-based review of lumbar transforaminal epidural steroid injections (ESI), published in the most recent issue of Pain Medicine ⇓. Surprisingly, the conclusions of MacVicar et al.'s review contrast with those of the recent systematic review by Pinto et al. published in the Annals of Internal Medicine ⇓. Both authors encountered the same body of literature. However, Pinto et al. reviewed both fluoro-guided and non-fluoro-guided lumbar ESI in the management of sciatica, and also included studies on the transforaminal, interlaminar, and caudal approaches to ESI. Although Pinto et al.'s analysis includes all epidural injections, thereby including studies not reviewed by MacVicar et al., we question the clinical relevance of the authors' findings and challenge with their ultimate conclusions. Based on their comparison of active to control injections, Pinto et al. found that ESI, as a whole, had short-term statistically significant but not clinically significant benefits. The methodology is flawed for two reasons. At this point in time, most practitioners who perform interventional procedures recognize the clinical benefits of ESI. Therefore, the high-quality research performed often compares different procedural …