Rates of complications after cervical transforaminal epidural steroid injections for patients with cervical radiculopathy utilizing a large national database

Background

Cervical transforaminal epidural steroid injections (CTFESI) are commonly used to treat cervical radiculopathy. Though major adverse events have been published in case reports, larger cohort studies have not demonstrated this concern.

Objective

The purpose of this study was to assess the risk of major and minor complications after CTFESIs using a large database.

Methods

TriNetX, a global health research network, was queried from January 01, 2004–May 20, 2025 for patients with cervical radiculopathy undergoing CTFESI. All diagnostic and surgical codes after CTFESI were analyzed. Specific major complications queried for were stroke, seizures, and paralysis. Nervous system, musculoskeletal, infectious, and procedural diagnoses were evaluated for complications. Complications were reported as number and percent.

Results

A total of 32,913 patients underwent CTFESI with available follow-up data. There were ≤10 (≤0.03 %) patients who had intraoperative/post-procedure complications, ≤10 (≤0.03 %) with CSF leak. There were 143 (0.4 %) patients that had cerebral vascular disease related codes. Of these, 50 (0.15 %) had cerebral infarction codes and ≤10 (≤0.03 %). There were 39 (0.12 %) patients with seizure codes, and 18 (0.5 %) patients that had paralysis codes. There were 0 (0 %) patients who had mortality related codes within a day after CTFESI.

Conclusion

This study demonstrates the risk of major complications after CTFESI in a large cohort to be low.