The safety and efficiency of performing cervical transforaminal epidural steroid injections under fluoroscopic control on an ambulatory/outpatient basis

Abstract

Purpose Cervical transforaminal epidural steroid injections (CTFESIs) have become an increasingly utilised means of treating radicular pain over recent decades, although a number of reports have brought their safety into question. Much of this has been attributed to the use of particulate steroids and the theoretical risk of embolic complications with inadvertent intra-arterial injection. This study documents the complications encountered at our centre when performing CTFESI over a more than 10-year study period with predominant use of particulate steroid. Our procedural technique is also described. This study aims to highlight the importance of operator technique first and foremost and how, with safe and reproducible technique that confidently avoids intra-arterial injection, CTFESI can be performed safely irrespective of the choice of steroid. Methods All patients undergoing CTFESI between January 2008 and August 2018 at our centre were prospectively recruited to the study, documenting total number of injections/procedures per patient, presence of/description of complications and severity and type of steroid administered. Results Five hundred and twenty-seven patients underwent 1047 procedures (1753 individual cervical levels injected) over the study period: 1011 procedures performed with particulate steroid (triamcinolone acetonide) and 36 performed with nonparticulate (dexamethasone). Only six complications were encountered, all spontaneously self-resolving without intervention and considered minor (grade 1). Conclusions With fastidious safe technique, CTFESI can be safe, efficacious and cost-effectively administered on an outpatient basis. Predominant use of particulate steroids did not lead to any significant complications.

Spinal intramedullary hematoma presenting years following a cervical epidural injection

“…[ 1 , 4 , 7 , 8 ] CESI may contribute to spinal epidural hematomas and intramedullary cord injections/hematomyelia. [ 2 , 3 , 5 , 6 , 9 ] In this case, the patient’s the MRI-documented intramedullary C3-C6 cystic lesion proved at surgery (i.e. midline myelotomy) to be a chronic intramedullary hematoma.…”

Interventional Pain Procedures: A Narrative Review Focusing on Safety and Complications. Part 1 Injections for Spinal Pain

“…It is worth mentioning that some authors advocate for a complete avoidance of transforaminal injection at the cervical level, given the possibility of devastating neurological complications. 64 , 65 The physical properties of injected medications play a major role in the development of complications. Particulate steroid epidural injections contain particles of the steroid medication, while non-particulate steroid epidural injections are free of particles.…”

Therapeutic and diagnostic value of transforaminal epidural injections in patients with herniated disc and radicular pain: analytical literature review

“…Оценивая безопасность трансфораминальных эпидуральных блокад на шейном уровне, Bush et al [92] провели 1047 процедур у 527 пациентов. Лишь в шести случаях было отмечено развитие осложнений, самостоятельно разрешившихся без какихлибо вмешательств и признанных незначительными.…”