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Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial

BMJ 2011; 343 doi: (Published 13 September 2011) Cite this as: BMJ 2011;343:d5278

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Re: Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial

Dear Editors,

As we all know, lumbar canal stenosis is a fairly common problem. Management still remains quite challenging, with surgical decompression/ debridement / fusions/foraminotomy/ laminotomy, etc, being resorted to when NSAIDs, physical therapy and tractions, chiropractic manipulations, epidural steroid injections, acupunctures, etc stop being efficacious anymore. Lumbar canal stenosis is known to keep worsening usually with time, and even can lead to debilitating cauda equina syndrome.

Despite all its improvements and the advent of minimally invasive techniques, many patients continue to have reservations and apprehensions regarding surgery. In order to quantify this problem, we would like to mention out here what we have read somewhere, that an estimated 400,000 Americans suffer from leg pain and/or low back pain from lumbar spinal stenosis. This is a huge number for a single country.

In this context, we would now like to inform you BMJ, and the world thereby, that accidentally we have developed a non-invasive and a painless technique for managing lumbar stenosis. Once this information of a new and innovative non-invasive technique was somehow inadvertently got leaked out, we could not hold back, or deny the patients who thereafter came seeking our help from distant places for their problem of lumbar stenosis. We have tried extending this help totally free of cost to all these patients.

Our prime author, here, was the first patient, who found relief accidentally. He had been having claudications and foot drop as well, for which he had to stop and rest. He had this problem for over two to three decades and much before he had turned 50 years of age. He is 52 ½ years old now. Retrospectively, we suspect that he did have a narrow lumbar canal, possibly by birth. His father had similar problems, and they too were managed as promptly by this same technique. This non-invasive technique, which we would like to be called hereafter as “AGRA TECHNIQUE” for lumbar stenosis, requires no needles, no anaesthesia, no hospitalization, and is over in less than two hours in most cases, and the relief is also as prompt.

This technique may not be helpful in 100 % cases, but we believe that this “AGRA TECHNIQUE” could be very useful for early cases. But then it would require further refinement, so as to become more precise, totally safe even in a novice’s hands, more acceptable, etc. We could do just this much at our own, without any help or encouragement from any quarters. We do believe that vast number of patients around the world can be helped promptly and possibly for lasting intervals, by this innovative AGRA TECHNIQUE, which surely needs much more collaborative research for enhancing refinement, precision, safety, and for prolonging relief, and for increasing success rates. This technique could be used as an alternative for those patients who are not prepared for undergoing surgery, or are unfit to be undertaken for surgery for presence of other co-morbidity which might place added risk for surgery or anaesthesia.

Best regards.

Competing interests: This technique was an accidental development.

04 November 2013
Dr (Lt Col) Rajesh Chauhan
Consultant Family Medicine & Hon' National Professor (IMA CGP)
Dr. Ajay Kumar Singh Parihar, Dr. Shruti Chauhan.
Family Healthcare Centre, Avas Vikas Colony Sikandra, AGRA.
154 Sector 6-B (HIG), Awas Vikas Colony, Sikandra, AGRA -282007. INDIA.