Complications of Spinal Diagnostic and Treatment Procedures

Abstract

A B S T R A C TBackground. Spinal intervention procedures are widely practiced. Complications are sometimes described in case reports, but the full spectrum of possible complications has not been comprehensively publicized. The fact that certain complications continue to occur suggests that practitioners may not be fully aware of the nature of possible complications and how to recognize warning signs.Objectives. To highlight the nature of potential complications of spine interventions and to assist practitioners in recognizing warning signs of impending complications so that they might be prevented.Methods. Complications described in the literature and encountered by the authors in medicolegal proceedings were identified. Illustrations of such complications were collated together with illustrations of phenomena that might have led to complications had they not been recognized and the procedure appropriately corrected or abandoned.Results. Infection is a risk common to all invasive procedures. Spinal cord injuries have occurred during cervical medial branch blocks, intra-articular injections, and radiofrequency neurotomy because operators did not obtain correct views of the target region and misdirected their needles or electrodes. Similar errors have occurred in the conduct of lumbar blocks and neurotomy. The complications of lumbar intradiscal procedures include infection, injury to a ventral ramus, and breakage of electrodes. Cervical discography, additionally, can be complicated by spinal cord injury. Cervical transforaminal injections have been complicated by injections into a reinforcing radicular artery or the vertebral artery. Lumbar transforaminal injections have been complicated by intraarterial injections and subdural or intrathecal injections. Epidural injections can be complicated by subdural or intrathecal injections, or venous puncture resulting in a haematoma. Intra-articular injections of the lateral atlantoaxial joint and sacroiliac joint theoretically could be complicated by injury to adjacent vessels, nerves, or viscera.Discussion. Strict adherence to published guidelines provides safeguards against encountering complications. Complications are avoided by operators knowing all the relevant anatomy of the procedure and being able to recognize aberrations in the procedure as soon as they occur.

Transforaminal injection of corticosteroids for lumbar radiculopathy: systematic review and meta-analysis

“…A recent systematic review has found that there was no significant difference between transforaminal and caudal epidural injection [39]. Transforaminal injection of steroids can be hazardous [40][41][42], and especially if carelessly performed. Guidelines for the safe conduct of transforaminal injections have been published by the International Spinal Intervention Society [43], emphasizing particularly the need to be vigilant for unintended, intra-arterial injection of particulate steroids.…”

Association between Magnetic Resonance Imaging and the Result of Medial Branch Blocks

“…The zygapophysial joint was identified as a pain source with one or two medial branch blocks at different appointments in the practice, each with about 1 ml of bupivacaine (0.25%) and 20 mg triamcinolone. Injections were performed with fluoroscopic visualization using established techniques [1]. A positive response to the medial branch block required at least 50% pain relief.…”

“…Therefore, the most accepted method [1] for diagnosing zygapophysial joint pain is controlled medial branch blocks. They are used to test if the pain stems from the zygapophysial joint because the medial branch innervates it [1].…”

“…The identification of a zygapophysial joint as a pain source is difficult, because no aspect of the patient's history or physical examination characteristics can identify a joint as the cause of pain [2] [3]. Therefore, the most accepted method [1] for diagnosing zygapophysial joint pain is controlled medial branch blocks. They are used to test if the pain stems from the zygapophysial joint because the medial branch innervates it [1].…”

“…The zygapophysial joints are a possible pain source for which radiofrequency denervation exists as a specific treatment. A valid diagno-sis of lumbar zygapophysial joint pain provides the cardinal indication for treatment with medial branch neurotomy [1]. The identification of a zygapophysial joint as a pain source is difficult, because no aspect of the patient's history or physical examination characteristics can identify a joint as the cause of pain [2] [3].…”