We thank Dr. Rathmell et al.  for emphasizing the potential hazards of transforaminal injections.1It is clear that these injections should be performed by individuals who are fully trained in advanced imaging and interventional techniques. Moreover, the practitioner must be capable of managing any adverse sequelae.

Although the treatment of radiculopathic pain with the local injection of corticosteroid is appreciated, we believe that the best treatment of radiculopathic pain is by the application of pulsed radiofrequency current to the involved dorsal root ganglion. In our extensive experience with pulsed radiofrequency, we have found the results of treatment to be superior to those of conventional corticosteroid injections in both effectiveness and duration.2,3Furthermore, pulsed radiofrequency application exposes patients to less risk for the following reasons: (1) Cannula placement can be performed based solely on osseous anatomy and electrophysiologic stimulation results. Therefore, no injection of any material is requisite. (2) The patient is exposed to no systemic sequelae of medication or radiocontrast administration. (3) Unlike injection therapies, pulsed radiofrequency can be repeated as indicated, without fear of accumulating medicinal toxicity.

The only potential disadvantage to the use of pulsed radiofrequency versus  injection therapy is the requirement of a larger cannula (20–22 vs.  26 gauge) that could cause more tissue trauma. Regardless, the take-home message is well elucidated by the authors. Spinal interventional techniques should only be performed by practitioners who have demonstrated expertise in neuraxial imaging for interventional treatment modalities.

* Medical College of Georgia, Augusta, Georgia. damartin@mail.mcg.edu

Rathmell JP, Aprill C, Bogduk N: Cervical transforaminal injection of steroids. Anesthesiology 2004; 100:1595–600
Sluijter ME, Cosman ER, Rittman WB, Van Kleef M: The effects of pulsed radiofrequency fields applied to dorsal root ganglion: A preliminary report. Pain Clin 1998; 2:109–17
Mikeladze G, Espinal R, Finnegan R, Routon J, Martin D: Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain. Spine J 2003; 3:360–2