Comments on “Enhancing contrast distribution with the far lateral approach in lumbar transforaminal epidural steroid injections: A retrospective analysis”
Bibliographic record
Abstract
We read with great interest the article titled, “Enhancing contrast distribution with the far lateral approach in lumbar transforaminal epidural steroid injections: A retrospective analysis,” by Yang et al.1 The study included patients having herniated intervertebral discs with radiculopathy and compared the contrast distribution patterns after conventional transforaminal epidural steroid injection (C-TFESI) and far lateral recess TFESI (FLLR-TFESI). The contrast pattern was reportedly better after FLLR-TFESI than after C-TFESI. In their study, a better contrast pattern was defined as a greater spread to the posterior epidural space, anterior epidural space, and ipsilateral lateral recess. Pain management injection procedures are more effective if the injectate is administered at or near the lesion.2 Similarly, to achieve a superior pain management effect of TFESI in patients with herniated intervertebral discs, corticosteroids with or without an anesthetic should be injected at or near the herniated intervertebral discs. The definition of a better contrast pattern by Yang et al. appears reasonable only if the prolapsed lumbar disc is located within the spinal canal. If herniated intervertebral discs appear in the foramen or extraforaminal area, more injectate should be administered for better treatment outcomes. For patients with foraminal or extraforaminal herniated lumbar discs, injection procedures would be better performed using the C-TFESI method, with the needle tip positioned on the lateral area within the safety triangle (Figure 1). Yang et al. appear not to have considered the fact that disc herniation can occur in the foraminal or extraforaminal areas. In deciding on the TFESI method, the location of the disc herniation should be considered. M.C.C.: writing of the original draft; M.B.-R.: review and editing of the manuscript; S.Y.: supervision, and review and editing of the manuscript. All authors participated and acted as an author and gave their input and feedback. The authors have nothing to report. The authors declare no conflict of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.108 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.020 | 0.015 |
| Insufficient payload (model declined to judge) | 0.003 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".