interestingly, your eyes seem to show something that you profess is seen by others but that i and some others can definitively state is not.
and what you are uniquely seeing is so evident - prove it. study it, and publish it. study it the right way - with a double blinded randomized study, not a retrospective case review where you decide the results. .
or find research and post it that supports your point.
or acknowledge that what you are quoting is at best expert opinion and no further and should not be considered dogma, because that is the feeling i get from reading the posts.
You are delusional. Research isnt binary. It is graded on a continuum. It can have flaws and be downgraded. It can mean absolutely nothing when N is underpowered, methodology is compromised, bias is overpowering, etc.
there are no real good studies that suggest epidural injections really work for stenosis in the first place.
I would disagree with your assessment about dex vs. depo. the difference in my experience and some of the colleagues I talk to is a matter of 1-2 weeks.
I agree that there are no good studies on stenosis, because those patients are much harder to find, stratify, and include in a study. This why steve and you stating that dex is just as good as depo is wrong, because the dex vs depo studies were performed on acute radiculopathy only, and not for stenosis which has different pathophysiology.
You can disagree with my assessment all you want, but you are mistreating your patients if you do so.
Just today I had a patient come back with a fairly common difficult to treat issue, 50 something patient with L5-S1 degenerative bulge with mild-moderate lateral recess stenosis s/p L5-S1 discectomy in distant past. Previous physician did S1 TFESI with dex x 2, patient only had relief for 2 days after each epidural, I did an S1 TFESI with depo and the patient came back to me just now because he had excellent relief for 4 months!
75% of the time I see the same results in patients with the common L4-L5 grade 1 spondylolisthesis and moderate stenosis. Patients obtains a week of relief after L5-S1 TFESI with dex, and then 5 months of relief after L5-S1 ILESI with depo
I have saved literally hundreds of patients from lumbar fusion surgery by doing ESI with depo on patients who failed ESI with dex. You and Steve are doing your patients a great disservice by never offering them lumbar ESI with depo.
Duct, you might not be seeing the best results with your procedure regardless of steroid because you and your hospital colleagues treat a disproportionate amount of medicaid and medi-medi patients, and interventions hardly ever work on that population because they need a psychiatrist much more than a pain physician.
Steve, my point regarding that facet study is that it did not disprove my point regarding IA facets on patients under 60. It didn't separate out patients into age groups and so that study doesn't disprove my theory at all. It didn't prove I was wrong, or right, it just didn't influence the argument because of how it was designed.
We could do a study comparing a blood pressure pill and the study would include an equal amount of people from 20 yrs to 90yrs old. This study would evaluate how often people became dizzy or fall while taking a full dose of the medication. The young patients have more cardiac reserve and would do better than the older sicker patients and would skew the data the researchers didn't stratify the participants by age. Similar deficiency in the facet study.
