Purpose
Epidural steroid injections (ESI) has been used in the treatment of radicular pain caused by herniated intervertebral disc or spinal canal stenosis.
Although ESI are widely used as an effective treatment for spinal origin pain,
there is still a debate about its safety.
4-23-2014, U.S.
Food and Drug Administration (FDA) warned that injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events,
including loss of vision,
stroke,
paralysis,
and death.
In recent years,
dexamethasone,
a non-particulate steroid,...
Methods and Materials
1.
Patients
This retrospective study was approved by the institutional review board,
which waived the need for informed consent. A total of 1463 patients underwent consecutive spinal steroid injections from January to June,
2017 (Fig.
1,
Table 1).
1) inclusion criteria
.
Individuals receiving ESIs using dexamethasone via interlaminar,
transforaminal,
and caudal approach
.
Individuals having follow-up telephone interview within 2weeks of the procedure
2) Exclusion criteria
.
Facet joint injections performed alone or with ESI
.
No follow-up phone call interview
.
Half dose...
Results
There were no immediate adverse reactions that interrupted the procedure.
Total delayed adverse reactions occurred in 56 patients (6.8%) in a two-week follow-up period.
The most frequent adverse reaction was increased pain (2.3%),
followed by facial flushing (Table 4).
Total delayed adverse reactions occurred more frequently at cervical level than at the lumbosacral level (Table 5,
Table 6).
No major complications requiring hospitalization occurred.
Conclusion
This study presented that major complications are quite rare,
but minor systemic adverse reactions are not uncommon in fluoroscopically guided ESI with dexamethasone when performed by expert hand and proper technique.
Thus,
these adverse reactions should be well recognized and properly managed.
References
Botwin KP,
Gruber RD,
Bouchlas CG,
Torres-Ramos FM,
Freeman TL,
Slaten WK.
Complications of fluoroscopically guided transforaminal lumbar epidural injections.
Archives of physical medicine and rehabilitation 2000; 81:1045-1050
Cohen SP,
Bicket MC,
Jamison D,
Wilkinson I,
Rathmell JP.
Epidural steroids: a comprehensive,
evidence-based review.
Regional anesthesia and pain medicine 2013; 38:175-200
Derby R,
Lee SH,
Date ES,
Lee JH,
Lee CH.
Size and aggregation of corticosteroids used for epidural injections.
Pain medicine (Malden,
Mass) 2008; 9:227-234
Dreyfuss P,
Baker R,
Bogduk N.
Comparative effectiveness of...
