Complications Associated with Lumbar Transforaminal Epidural Steroid Injections
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ANESTHETIC TECHNIQUES IN PAIN MANAGEMENT (D WANG, SECTION EDITOR)
Complications Associated with Lumbar Transforaminal Epidural Steroid Injections Andrew Chang 1 & Andrew T. Ng 1 Accepted: 10 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Low back pain with radicular symptoms is a common cause of disability in the adult population in the USA. Lumbar transforaminal epidural steroid injection (TFESI) is one of the most frequently used intervention for lumbar radiculitis. The purpose of this review is to evaluate complications associated with lumbar TFESI. Recent Findings Based on the literature review, the reported rate of minor complications was between 2.4 and 9.6%. The major complications including spinal abscess, spinal cord infarct, and epidural hematoma were documented as case reports. Some patients with spinal cord infarct had permanent neurologic deficits, while the other patients had recovery of neurological function after surgical or medical intervention. Summary This review identifies both the minor and major complications related to lumbar transforaminal epidural steroid injections. According to this review, most complications are minor. Lumbar TFESI can be considered a safe treatment in the management of lumbar radicular pain. However, pain specialists should be aware of the potentially devastating major complications. Early recognition and treatment of complications are crucial for improving the outcome. Keywords Low back pain . Radicular symptoms . Lumbar transforaminal epidural injection . Epidural hematoma . Epidural abscess . Spinal cord infarction
Introduction Low back pain (LBP) is a common complaint in clinical settings. LBP is also a common cause of disability in the adult population in the USA. The lifetime prevalence of LBP was reported to be as high as 84% [1]. The prevalence of lumbosacral radiculopathy is 3–5% of the population and equally distributed between men and women [2]. Conservative management of radicular symptoms is considered first with medications (e.g., non-steroidal anti-inflammatory drugs (NSAIDs), membrane stabilizer medications, and acetaminophen), physical therapy, acupuncture, chiropractic manipulation, and traction. When conservative measures fail, This article is part of the Topical Collection on Anesthetic Techniques in Pain Management * Andrew T. Ng [email protected] 1
Jefferson Pain Center, Department of Anesthesiology, Division of Pain Medicine, Thomas Jefferson University Hospital, 3 Crescent Drive, Philadelphia, PA 19112, USA
interventions such as epidural injections will become necessary as the next step treatment. The treatment of radicular symptoms with lumbar epidural steroid injections was first reported in the 1960s [3]. It was shown to be effective in relieving pain related to lumbar disc herniation and lumbar spinal stenosis [4, 5]. Statistics show that epidural injections are the most commonly performed interventional procedures in managing spinal pain [6]. Spine injections increase
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