Letter to editor - Intradiscal steroid injection for lumbar canal stenosis: novel but not yet ready for clinical adoption

Sep 29, 2026

Letter to the editor evaluating a retrospective cohort study on intradiscal steroid injection for spinal stenosis. The authors argue the evidence is level III and should not be treated as conclusive, highlighting limitations in univariable analysis, missing multivariable predictors, and insufficient reporting of technique, fluoroscopic reproducibility, chemical incompatibility, discography details, and epidural spread. They question outcome duration, imaging follow-up, standardized conservative care, and repeated-measures statistics with intra-patient correlation. The letter concludes that cautious interpretation and prospective controlled trials with imaging are required before clinical adoption.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Letter to the editor

Study design and reporting

Technique-related concerns

Clinical outcomes

Statistical considerations

Safety and complications

Interpretation and context

Letter to the Editor ASJ Asian Spine J. 2025;19(6): 1107-1108 [https://doi.org/10.31616/asj.2025.0633.r1](https://doi.org/10.31616/asj.2025.0633.r1)[ ](https://doi.org/10.31616/asj.2025.0633.r1)PISSN 1976-1902 • eISSN 1976-7846 Letter to editor: Intradiscal steroid injection for lumbar canal stenosis: novel but not yet ready for clinical adoption Gauri Khurana, Varun Singla, Babita Ghai Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India Received Sep 30, 2025; Accepted Oct 12, 2025 Corresponding author: Varun Singla Anaesthesia Office, Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, OT complex, 4th Floor, Nehru Block, PGIMER, Chandigarh 160012, India Tel: +91-8427474087, E-mail: [drvarunsinglapgi@gmail.com](drvarunsinglapgi@gmail.com) To the Editor, We read with interest the article by Kim et al. [1],“Effectiveness of intradiscal steroid injection for spinal stenosis: a retrospective cohort study in South Korea.”While the topic is clinically relevant, several methodological and interpretive issues warrant clarification. Study design and reporting This retrospective analysis constitutes level III evidence and should not be interpreted as conclusive. Only univariable comparisons were presented; a multivariable approach incorporating laterality, Modic changes, Pfirrmann grade, and comorbidities could better predict surgical conversion. Technique-related concerns Performing intradiscal steroid injection (ISI) in the lateral position rather than prone raises concerns about fluoroscopic reproducibility. Furthermore, mixing ropivacaine with dexamethasone is chemically incompatible, yet this combination was used without justification [2]. The description of provocative discography lacked essential details (contrast volume, injection pressure), which are critical per standardized guidelines [3,4] . Reporting of epidural spread, necessary to confirm intradiscal localization, was absent. Clinical outcomes Pain relief was assessed up to 6 weeks, but no longerterm outcomes or magnetic resonance imaging followup were provided to evaluate potential disc degeneration. Although histologic safety data were cited, imaging confirmation within the study cohort is lacking. Moreover, details regarding concurrent conservative treatments (physiotherapy, analgesics, neuropathic agents) and whether they were standardized between groups were not described. Statistical considerations Repeated measures of pain scores were analyzed without accounting for intra-patient correlation. Repeatedmeasures analysis of variance with Bonferroni correction, or nonparametric alternatives, would have been more appropriate. The interval to surgical conversion beyond 6 weeks also requires clarification. Copyright Ⓒ 2025 by Korean Society of Spine Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([http://creativecommons.org/licenses/by-nc/4.0/](http://creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Asian Spine Journal • pISSN 1976-1902 eISSN 1976-7846 • [www.asianspinejournal.org](www.asianspinejournal.org) Safety and complications Though no subdural injections were reported, the verification method was not described. Explicit reporting of infection surveillance is essential for safety interpretation. Interpretation and context Recent systematic reviews suggest that intradiscal glucocorticoid injections may provide significant shortterm pain and functional improvement, but these benefits diminish beyond 3–6 months [5]. Similarly, metaanalyses of epidural steroid injections for lumbar disc herniation and stenosis confirm only short-term relief, with little durable effect [6,7]. These findings

FAQs

What is the main concern about the study design in the cited retrospective cohort analysis?

The letter states the analysis provides level III evidence and should not be interpreted as conclusive. It emphasizes the use of only univariable comparisons and the need for multivariable prediction including laterality, Modic changes, Pfirrmann grade, and comorbidities.

Which technique and reporting issues are raised regarding intradiscal steroid injection?

Concerns include performing injection in the lateral position and potential fluoroscopic reproducibility issues, as well as chemical incompatibility between ropivacaine and dexamethasone without justification. The authors also note missing discography details (e.g., contrast volume, injection pressure), absent reporting of epidural spread, and inadequate verification information for safety.

What evidence does the letter say is still missing before adopting ISI clinically for lumbar canal stenosis?

The letter highlights limited follow-up for pain relief (up to 6 weeks) without longer-term outcomes or MRI follow-up, lack of imaging confirmation within the cohort, unclear standardization of concurrent conservative treatments, and incomplete complication surveillance reporting. It concludes that prospective controlled studies with imaging follow-up are essential before ISI can be considered a viable alternative.

Sep 29, 2026

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