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High or Low? Assessment of Spinal Cord Stimulation Complication Rates Depends on Perspective

Origins of Epidural Corticosteroid Therapy Gardner et al.1 first tried epidural injections using 30 mL 1% procaine and 125 mg hydrocortisone in a series of 239 patients with sciatica or failed back surgery. In most of these cases, they had difficulty locating the epidural space, and they placed the injection into the intrathecal space using a mixture of 80 mg of methylprednisolone acetate (MPA; DepoMedrol, Pfizer, Inc.) and 40 mg procaine in 75 subjects with sciatica of undefined etiology. Forty-five patients (60%) had “. . . relief of sciatica for periods of more than 4 months.” However, the details of improvement as documented by a formal neurologic examination were undefined, and there was no randomization or control group. Winnie et al.2 further popularized this approach with a case series on acute radicular pain. They documented that a potent corticosteroid administered in a small volume of diluents placed near the affected nerve root was particularly efficacious in patients with sciatica.