Response to the letter to the editor - Effectiveness of intradiscal steroid injection for spinal stenosis - a retrospective cohort study in South Korea

Sep 29, 2026

A response letter addresses peer feedback on a retrospective cohort study evaluating intradiscal steroid injection (ISI) for lumbar spinal stenosis in South Korea. The authors clarify the exploratory study aim of achieving short-term pain relief and delaying surgery rather than proving definitive cure, and they discuss the statistical reasoning behind univariable comparisons. They justify lateral decubitus positioning for comfort and stable fluoroscopy, address dexamethasone–ropivacaine compatibility as primarily theoretical, and report clinical safety in a cohort of 260 patients, including injection practice and imaging confirmation methods.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

Study design and statistical approach

Technique-related concerns

Patient positioning

Injectate compatibility

Discography procedure details

Clinical outcomes and follow-up

Statistical considerations

Letter to the Editor ASJ Asian Spine J. 2025;19(6): 1109-1111 [https://doi.org/10.31616/asj.2025.0633.r2](https://doi.org/10.31616/asj.2025.0633.r2)[ ](https://doi.org/10.31616/asj.2025.0633.r2)PISSN 1976-1902 • eISSN 1976-7846 Response to the letter to the editor: Effectiveness of intradiscal steroid injection for spinal stenosis: a retrospective cohort study in South Korea Jin Hwan Kim1, Sung Tan Cho2, Byung Jik Kim1, Su Whi Chae1, Wongthawat Liawrungrueang3 1Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University, Goyang, Korea 2Department of Orthopaedic Surgery, Seoul Seonam Hospital, Seoul, Korea 3Department of Orthopaedic Surgery, School of Medicine, University of Phayao, Phayao, Thailand Received Oct 13, 2025; Accepted Oct 14, 2025 Corresponding author: Sung Tan Cho Department of Orthopaedic Surgery, Seoul Seonam Hospital, 20 Sinjeong ipen 1-ro, Yangcheon-gu, Seoul 08049, Korea Tel: +82-2-6300-9178, Fax: +82-2-6300-9178, E-mail: [osdoctor0712@gmail.com](osdoctor0712@gmail.com) We sincerely appreciate the reader’s thoughtful comments and critical appraisal of our study,“Effectiveness of intradiscal steroid injection for spinal stenosis: a retrospective cohort study in South Korea [1] .” The concerns raised provide valuable opportunities to clarify aspects of our methodology and interpretation. We address each point below. Study design and statistical approach We agree that our retrospective design represents level III evidence and that multivariable analysis could further elucidate predictors of surgical conversion. Our primary objective, however, was exploratory—to determine whether intradiscal steroid injection (ISI) could provide meaningful short-term pain relief and delay the need for surgery in patients with lumbar spinal stenosis. Because the study population was relatively homogeneous, univariable comparisons were considered appropriate for this initial investigation. Nevertheless, we fully acknowledge that prospective, controlled studies with multivariable modeling are needed to validate and refine these findings. Technique-related concerns We appreciate the comments regarding patient positioning and injectate compatibility. The lateral decubitus position used in our study is consistent with the conventional approach applied in diagnostic discography. Based on our experience, this position allows patients to breathe more comfortably than the prone position, thereby enhancing procedural tolerance. Moreover, before needle insertion, the C-arm was adjusted to obtain true anteroposterior and lateral views, and the patient’s body was secured with tape to minimize motion, ensuring stable imaging throughout the procedure. Therefore, we believe that the lateral decubitus approach does not compromise fluoroscopic accuracy compared with the prone position. Regarding the mixture of dexamethasone andropivacaine, we are aware that this combination may exhibit limited physicochemical compatibility under certain conditions. However, it is important to note that their letter primarily raised a theoretical concern rather than reporting any clinical adverse events. Infact, numerous clinical studies involving nerve blocks, intra-articular injections, and intradiscal procedures 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) have used this combination safely without evidence of precipitation or clinically significant reactions. In our own cohort of 260 patients, the mixture was freshly prepared and immediately administe

FAQs

What was the primary objective of the ISI study discussed in the response?

The primary objective was exploratory: to see whether intradiscal steroid injection could provide meaningful short-term pain relief and delay surgery in patients with lumbar spinal stenosis.

Why did the authors use the lateral decubitus position for injection?

They used lateral decubitus because it aligns with the conventional approach in diagnostic discography and allows patients to breathe more comfortably than the prone position, while maintaining stable fluoroscopic imaging.

What did the authors report regarding the safety of dexamethasone–ropivacaine use?

The response notes that the concern was theoretical and that, in their cohort of 260 patients, the mixture was prepared freshly and administered under fluoroscopic guidance with no procedure-related complications such as infection, hematoma, or chemical neuritis.

Sep 29, 2026

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