Safety profile of cervical transforaminal epidural steroid injections performed while maintaining anticoagulation, aspirin, or NSAIDs

Abstract

Summary of background data

The risk of a symptomatic epidural bleed in patients continuing anticoagulation during most types of spinal injection procedures is extremely low. Cervical epidural steroid injections involve a unique risk of a catastrophic complication if an epidural hematoma is to occur secondary to spinal cord compression due to the anatomic confines of the cervical spinal canal. There is minimal research on the risk of cervical transforaminal epidural steroid injections (CTFESI) with anticoagulation.

Objective

Evaluate the risk of performing CTFESI with patients continuing prescribed anticoagulation medication.

Methods

A retrospective review was performed at two practice settings, a community-based outpatient practice and an academic practice, to identify all CTFESI performed between June 2018 through November 2023. Patient medical records were reviewed for the presence of anticoagulation and NSAID medication the day of the CTFESI. Data analysis used descriptive statistics to summarize the distribution of anticoagulants, NSAIDs, and cervical levels across practices, along with medication frequencies and percentages.

Results

A total of 2792 CTFESIs were performed across both settings between June 2018 and November 2023. Of those, 1040 CTFESIs (37.2 %) were performed on patients taking some form of anticoagulant medication. 277 CTFESI were performed on patients taking anticoagulants or aspirin or a combination of anticoagulants and ASA. 763 were performed on patients taking NSAIDs. There were no reported cases of symptomatic epidural hematomas or other bleeding complications in the immediate post-procedural period or up to 1 week following the procedure.

Conclusion

It is likely that CTFESI can be safely performed in patients continuing anticoagulation, aspirin (ASA), or NSAIDs. Discontinuing anticoagulants or NSAIDs for CTFESIs may not be necessary. Further studies are warranted to confirm these results.