An assessment by the BlueCross BlueShield Association Technology Evaluation Center (BCBSA, 2014) stated: "The choice of bone material for interbody fusion in [anterior cervical discectomy and fusion] ACDF has important clinical implications. Allograft bone has several drawbacks, including a minute (albeit unproven) risk of infectious disease transmission; possible immunological reaction to the allograft; and possible limited commercial availability of appropriate graft material. In contrast, the use of autograft bone in ACDF has potentially substantial morbidities at the harvest site, generally the iliac crest. These include moderate-to-severe, sometimes prolonged pain; deep infection; adjacent nerve and artery damage; and increased risk of stress fracture. Although there may be slight differences between autograft and allograft sources in the postoperative rate of union, clinical studies have demonstrated similar rates of postoperative fusion (90%–100%) and satisfactory outcomes for single-level, anterior-plated ACDF using either bone source. Thus, the choice of graft material involves a trade-off between the risks specific to autograft harvest versus those specific to use of allograft material."
DePalma and colleagues (2005) reviewed the evidence on the effectiveness of transforaminal epidural steroid injections (TFESI) or SNRBs to treat lumbosacral radiculopathy. These investigators concluded that there is moderate evidence in support of TFESI in treating painful lumbar radicular symptoms. The authors concluded that current studies support the use of TFESI/SNRB as a safe and minimally invasive adjunct treatment for lumbar radicular symptoms. In a critique of the systematic evidence review by DePalma et al, the Centre for Reviews and Dissemination (2008) stated that relevant data might have been missed as only published English language studies were included in the review. The CRD noted that the authors of this systematic review used published methods to assess the quality of the studies, but it is unclear how the studies were selected and how many reviewers performed the validity assessments; it is therefore difficult to assess the reliability, in terms of reviewer error or bias, of these review methods. The CRD observed that it appears that one study was initially included in the review, but then subsequently excluded from the analysis as it was not a true randomized controlled clinical trial. The CRD stated that, given the variability between the studies, in particular differences between the outcome measures and interventions, the authors' decision to use a narrative synthesis appears reasonable. The authors also noted a number of design problems with the included studies: the lack of a true placebo-control group and the lack of a sham control group. The studies were also limited in size, with only 2 studies having over 50 participants. The CRD concluded that, "[g]iven the variability between the studies, the lack of appropriate controls, and the limited number of studies and participants, the authors' cautious conclusions appear reliable."
The following patients should not have this injection: if you are allergic to any of the medications to be injected, if you are on a blood-thinning medication (. Coumadin, injectable Heparin), or if you have an active infection going on. With blood thinners like Coumadin, your doctor may advise you to stop this for 4-7 days beforehand or take “bridge therapy” with Lovenox prior to the procedures. Anti-platelet drugs like Plavix may have to be stopped for 5-10 days prior to the procedure. Aspirin should be stopped for cervical procedures for 10 days prior, but not for Lumbar.