Question special
Chief Resident

Among the study exclusion criteria were "Treatment for the current episode of sciatica with epidural spinal injection" and "ongoing exercise-based physiotherapy."

In our practice and many other US centers, injections are frequently employed as a critical component of both the diagnostic work-up, and the non-operative armamentarium.

Indeed, many of the best surgical candidates experience very meaningful but ultimately transient symptomatic relief from an injection. In these individuals, their injection response provides convincing evidence that they will benefit from surgery, while theoretically providing a subset of patients sufficient relief to avoid surgery altogether.

With these considerations in mind, can you comment on the motivation for that exclusion? Was a subgroup analysis considered as an alternative? And how would you recommend interpreting your study results when practicing in a patient population where a significant fraction will have undergone epidural spinal injections?