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- Nov 11, 2006
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Ok - I need some advice. I am meeting with an insurer who wants to stop paying for interlaminar ESI's citing lack of evidence. I have been asked to participate in a "round table" discussion on the best evidence for interlaminar ESI vs TFESI for chronic radicular pain. The best studies for head to head comparison I can
find are:
Thomas E, Cyteval C, Abiad L, Picot MC, Taourel P, Blotman F.
Efficacy of transforaminal versus interspinous corticosteroid injection
in discal radiculalgiaa prospective, randomized, doubleblind
study. Clin Rheumatol 2003;22:299-304.
Kraemer J, Ludwig J, Bickert U, Owczarek V, Traupe M. Lumbar
epidural perineural injection: a new technique. Eur Spine J 1997;
6:357-61.
Kolsi I, Delecrin J, Berthelot JM, Thomas L, Prost A, Maugars Y.
Efficacy of nerve root versus interspinous injections of glucocorticoids
in the treatment of disk-related sciatica. A pilot, prospec tive, randomized, double-blind study. J Bone Spine
2000;67:113-8.
My argument for doing interlaminars in the C-spine is that there is no strong evidence one way or the other and since I don't have DSA at the moment interlaminars seem safer given the recent concerns with TFESI. In the L-spine I really almost always do TFESI but I want the option to keep doing them. Any help would be welcome. My other argument is that with bilateral LE symptoms I would often need to do bilateral TFESI if the 1st one only covered half the pain area, thus more than doubling the cost.
Signed,
Frustrated with the System
find are:
Thomas E, Cyteval C, Abiad L, Picot MC, Taourel P, Blotman F.
Efficacy of transforaminal versus interspinous corticosteroid injection
in discal radiculalgiaa prospective, randomized, doubleblind
study. Clin Rheumatol 2003;22:299-304.
Kraemer J, Ludwig J, Bickert U, Owczarek V, Traupe M. Lumbar
epidural perineural injection: a new technique. Eur Spine J 1997;
6:357-61.
Kolsi I, Delecrin J, Berthelot JM, Thomas L, Prost A, Maugars Y.
Efficacy of nerve root versus interspinous injections of glucocorticoids
in the treatment of disk-related sciatica. A pilot, prospec tive, randomized, double-blind study. J Bone Spine
2000;67:113-8.
My argument for doing interlaminars in the C-spine is that there is no strong evidence one way or the other and since I don't have DSA at the moment interlaminars seem safer given the recent concerns with TFESI. In the L-spine I really almost always do TFESI but I want the option to keep doing them. Any help would be welcome. My other argument is that with bilateral LE symptoms I would often need to do bilateral TFESI if the 1st one only covered half the pain area, thus more than doubling the cost.
Signed,
Frustrated with the System
