No major complications seen in a retrospective review of 1,018 cervical transforaminal epidural steroid injections

Abstract

Background

Cervical transforaminal epidural steroid injections (CTFESI) are commonly used to treat cervical radicular pain, but concerns remain about their safety due to case reports of complications such as stroke, spinal cord injury and death. These complications have been associated with use of particulate steroids causing embolic infarcts from inadvertent intra-arterial injection. With the use of non-particulate steroids these complications have never been reported. Additionally, recent cohort studies have demonstrated safety. Yet many providers still consider these procedures to be unsafe. Additional work is needed to further elucidate the risk of complications after CTFESI.

Objective

The goal of this study is to demonstrate the safety of CTFESI in a large retrospective cohort study using non-particulate steroids.

Methods

Medical records of all consecutive patients who underwent CFTESI within a tertiary academic multidisciplinary spine center from December 2002 through September 2024 were retrospectively reviewed. Data collected included vertebral level of injection, major (stroke, seizure, spinal cord injury, and death) and minor (headache, diaphoresis, syncope) complications, ED/urgent care visits within 2 weeks of procedure, and length of follow up within the performing PM&R department.

Results

A total of 1018 CTFESI procedures involving 558 patients were reviewed. There were no major complications in our study and no patients necessitated an ED or urgent care visit. Of 1018 total procedures, 16 (1.57 %) were attempted and aborted mid-procedure. Of these, 3 procedures were aborted due to inability to access the neuroforamen, 6 procedures were aborted due to signs of vascular uptake and/or subjective symptoms of vascular uptake, 3 procedures were aborted due to patient inability to tolerate the procedure, and 4 procedures were aborted due to vasovagal response. Only 1 (0.01 %) procedure resulted in a vasovagal response (hypotension, bradycardia, dizziness) following completion of the procedure.

Conclusion

This study demonstrated no major complications after fluoroscopy guided CTFESI with use of non-particulate steroids and standard safety techniques.