SPINE Volume 39, Number 11, pp 924 ©2014, Lippincott Williams & Wilkins
LETTERS IN RESPONSE:
We appreciate the concerns and suggest further studies.
W
e thank Prof. Shantanna for his notes. The aim of the study was to assess whether the effect of steroids injection into the site of the pain would be different from that of systemic corticosteroid use. The intramuscular drug, triamcinolone acetonide, even in the paraspinal muscles, has systemic absorption and distribution. It differs from triamcinolone hexacetonide, which has potent local action, promoting chemical synovectomy of the joints.^ However, after a longer period, triamcinolone hexacetonide has also systemic distribution. Thus, the main difference between the 2 drugs is the local action of triamcinolone hexacetonide that was used in the experimental group. Sample size calculation and statistical errors were described, although a larger number of subjects could demonstrate more differences between groups for different parameters. Einally, we were concerned about our major difficulty that lies in the diagnosis. Does facet syndrome actually denounce patients with pain of facet origin ?^'^
Luiza Helena Ribeiro, MD, PhD Rita Neli Vilar furtado, MD, PhD Monique Sayuri Konai, MD Ana Beatriz Andreo, MD Andre Rosenfeld, MD Jamil Natour, MD, PhD
References 1. Staal JB, de Bie RA, de Vet HC, et al. Injection therapy for subacute and chronic low back pain: an updated Cochrane review. Spine 2009;34:49-59. 2. Boswell MV, Trescot AM, Datta S, et al. American Society of Interventional Pain Physicians. Interventional techniques: evidencebased practice guidelines in the management of chronic spinal pain. Pj¿«P/)ys2007;10:7-lll. 3. Revel M, Poiraudeau S, Auleley CR, et al. Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia. Proposed criteria to identify patients with painful facet joints. Spine 1998;23:1972-6.
The manuscript submitted does not contain information about medical device(s)/drug(s). Fundaçâo de Amparo a Pesquisa do Fstado de Sao Paulo grant funds were received to support this work. No relevant financial activities outside the submitted work. DOI: 10.1097/BRS.0000000000000306 924
www.spinejournal.com
May 2014
Copyright of Spine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
LETTERS IN RESPONSE:
We appreciate the concerns and suggest further studies.
W
e thank Prof. Shantanna for his notes. The aim of the study was to assess whether the effect of steroids injection into the site of the pain would be different from that of systemic corticosteroid use. The intramuscular drug, triamcinolone acetonide, even in the paraspinal muscles, has systemic absorption and distribution. It differs from triamcinolone hexacetonide, which has potent local action, promoting chemical synovectomy of the joints.^ However, after a longer period, triamcinolone hexacetonide has also systemic distribution. Thus, the main difference between the 2 drugs is the local action of triamcinolone hexacetonide that was used in the experimental group. Sample size calculation and statistical errors were described, although a larger number of subjects could demonstrate more differences between groups for different parameters. Einally, we were concerned about our major difficulty that lies in the diagnosis. Does facet syndrome actually denounce patients with pain of facet origin ?^'^
Luiza Helena Ribeiro, MD, PhD Rita Neli Vilar furtado, MD, PhD Monique Sayuri Konai, MD Ana Beatriz Andreo, MD Andre Rosenfeld, MD Jamil Natour, MD, PhD
References 1. Staal JB, de Bie RA, de Vet HC, et al. Injection therapy for subacute and chronic low back pain: an updated Cochrane review. Spine 2009;34:49-59. 2. Boswell MV, Trescot AM, Datta S, et al. American Society of Interventional Pain Physicians. Interventional techniques: evidencebased practice guidelines in the management of chronic spinal pain. Pj¿«P/)ys2007;10:7-lll. 3. Revel M, Poiraudeau S, Auleley CR, et al. Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia. Proposed criteria to identify patients with painful facet joints. Spine 1998;23:1972-6.
The manuscript submitted does not contain information about medical device(s)/drug(s). Fundaçâo de Amparo a Pesquisa do Fstado de Sao Paulo grant funds were received to support this work. No relevant financial activities outside the submitted work. DOI: 10.1097/BRS.0000000000000306 924
www.spinejournal.com
May 2014
Copyright of Spine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
