Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

Moon, Jangsup; Kwon, Hyung‐Min

doi:10.1159/000455069

Cited by 123 publications

(3 citation statements)

References 16 publications

(22 reference statements)

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“…In addition to these retrospective studies, there are multiple case reports of neurological events after TFESI [12,15,16]. To date, there are only 2 case reports of complications associated with NPS.…”

Section: Complicationsmentioning

confidence: 99%

"Efficacy of Particulate Versus Non-Particulate Transforaminal Epidural Steroid Injections in Relation to their Complication Risk"

Rupp

2021

BJSTR

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Background:The FDA released guidelines in 2014 addressing multiple reported neurological complications associated with epidural steroid injections. FDA findings were generalized and did not specify type of steroid. Various cohort studies and systematic reviews have compared particulate versus non-particulate corticosteroids, showing minimal differences in outcomes. Case series and systematic reviews revealed multiple cases of neurological compromise with particulate steroid injections, but none with non-particulate steroid injections. Despite these two premises, practitioners have strongly skewed towards utilizing particulate steroids for transforaminal epidural steroid injections. The Spine Intervention Society (SIS) published guidelines in 2019 taking a stronger stance in favor of the use of non-particulate steroids. This review aims to explore the literature on this controversial subject.Objectives: This study aims to review the current literature on efficacy for particulate versus non-particulate corticosteroid transforaminal epidural steroid injections in relation to the potential for neurological complications. Design: Narrative reviewMethods: Literature review of all available evidence was conducted via Google Scholar and PubMed databases. Search terms included: transforaminal epidural steroid injection complications and effectiveness of particulate versus non-particulates in transforaminal epidural steroid injections. Studies of exclusively interlaminar epidural steroid injections were excluded. Results:There are various studies and case reports citing neurological complications associated with particulate transforaminal steroid injections, ranging from spinal infarct and blindness to death. This is contrasted with no reported cases for dexamethasone. Multiple cohort studies and systematic reviews have been completed comparing the efficacy of particulate steroids to non-particulates. There appears to be a minimal but greater short-term benefit of particulates over non-particulates. This benefit disappears after 2 months in studies that include long-term follow up.Limitations: This is a limited narrative literature review comparing data ranging from case reports to randomized controlled trials. There was no standardization or secondary statistical data analysis. Further meta-analyses could focus on pooling data to draw broader conclusions.Conclusions: Numerous studies have shown minimal greater short-term benefit of particulates over non-particulates; however, after factoring in possible neurological risk with particulates, scales have heavily tipped in favor of use of non-particulate steroids. These findings support the use of non-particulate steroids in the context of documented safety concerns with particulate steroids.

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Section: Complicationsmentioning

confidence: 99%

"Efficacy of Particulate Versus Non-Particulate Transforaminal Epidural Steroid Injections in Relation to their Complication Risk"

Rupp

2021

BJSTR

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“…Spinal cord infarction following Cervical Transforaminal Epidural Steroid Injection is much more frequently reported, either by secondary thrombosis or by accidental extravasation of particulates within the medications [ 74 , 75 ]. Such injections have also been reported as a cause of cerebral infarction but mechanism is unclear.…”

Section: Missiles and Foreign Bodiesmentioning

confidence: 99%

A Systematic Review of the Causes and Management of Ischaemic Stroke Caused by Nontissue Emboli

Judge

Mello

Bradley

et al. 2017

Stroke Research and Treatment

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Introduction The inadvertent or purposeful introduction of foreign bodies or substances can lead to cerebral infarction if they embolize to the brain. Individual reports of these events are uncommon but may increase with the increased occurrences of their risk factors, for example, intra-arterial procedures. Method We searched EMBASE and MEDLINE for articles on embolic stroke of nontissue origin. 1889 articles were identified and screened and 216 articles were ultimately reviewed in full text and included in qualitative analysis. Articles deemed relevant were assessed by a second reviewer to confirm compatibility with the inclusion criteria. References of included articles were reviewed for relevant publications. We categorized the pathology of the emboli into the following groups: air embolism (141 reports), other arterial gas embolisms (49 reports), missiles and foreign bodies (16 reports), and others, including drug embolism, cotton wool, and vascular sclerosant agents. Conclusion Air and gaseous embolism are becoming more common with increased use of interventional medical procedures and increased popularity of sports such as diving. There is increasing evidence for the use of hyperbaric oxygen for such events. Causes of solid emboli are diverse. More commonly reported causes include bullets, missiles, and substances used in medical procedures.

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“…Interlaminar injection, transforaminal injection, and caudal injection are common ways for epidural drug injections. Spinal cord infarction is one of the complications of ESIs, but it had only been reported in patients by transforaminal injection via cervical vertebra [ 1 , 2 ] and by transforaminal injection via lumbar vertebra. [ 3 , 4 ] Up to now, no case had been reported to have spinal cord infarction caused by caudal injection.…”

Section: Introductionmentioning

confidence: 99%

Spinal cord infarction caused by sacral canal epidural steroid injection

et al. 2018

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Rationale:Spinal cord infarction is one of the complications of epidural steroid injections (ESIs), but has only been reported in cervical vertebra by transforaminal injection and lumbar vertebra by transforaminal injection; and up to now, there is no reporting about spinal cord infarction caused by caudal injection. Here, we report a case.Patient concerns:A 52-year-old man was admitted to our hospital. He was diagnosed as lumbar disc herniation in other hospital, and the patient suffered bilateral lower limb motor and sensory disorders after administration of caudal ESI.Diagnosis:Spinal cord infarction, tethered cord syndrome (TCS), and acute myelitis.Interventions:High doses of hormones, gamma globulin impact therapy, and rehabilitation were performed.Outcomes:The patient's condition was stable when he discharged from the hospital after 20 days of treatment. Discharge status: grade 0 of bilateral lower limbs muscle strength, inability to urinate and defecate by himself, slightly decreased touch, and needling sensation below the umbilical plane.Lessons:When patients are diagnosed with lumbar disc herniation and need to receive invasive treatments, magnetic resonance imaging (MRI) should be performed before the invasive procedures.

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Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

Cited by 123 publications

References 16 publications

"Efficacy of Particulate Versus Non-Particulate Transforaminal Epidural Steroid Injections in Relation to their Complication Risk"

"Efficacy of Particulate Versus Non-Particulate Transforaminal Epidural Steroid Injections in Relation to their Complication Risk"

A Systematic Review of the Causes and Management of Ischaemic Stroke Caused by Nontissue Emboli

Spinal cord infarction caused by sacral canal epidural steroid injection

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