ArticlesComplications of fluoroscopically guided transforaminal lumbar epidural injections☆,☆☆,★
Section snippets
Method
Patients presented to a multidisciplinary spine care practice with complaints of lower back and radicular pain. As part of a nonoperative treatment plan, patients received a combination of anti-inflammatory analgesics, referral to physical therapy, and transforaminal epidural steroid injections. All epidural injections were performed at an ambulatory surgery center using fluoroscopic guidance. Charts of all injections performed over a 4-month period on consecutive patients were retrospectively
Results
From 350 charts, 235 met retrospective design parameters. Patients received between 1 and 3 injections, with an overall average of 1.6 injections per patient. Complications were evaluated after each injection. Twenty-eight patients (11.9%) were lost to follow-up, which resulted in an overall drop-out rate of 28 injections (8%). None of these patients reported any side-effects. Thus, the study group was composed of a total of 207 patients with either HNP or LSS who underwent 322 injections.
The
Discussion
Epidural steroid injections have been used in the treatment of lumbar radicular pain syndromes since 1952.18 First reported in the United States in 1960, it was found to benefit conditions causing nerve root irritation.19 These injections were performed “blind” (without fluoroscopic guidance) using a translaminar “loss of resistance” technique. Even in experienced hands, improper localization of the epidural space using the blind technique has occurred in 13% to 30% of attempted injections.5, 6
Conclusion
Our retrospective review of the safety profile of fluoroscopically guided LTE steroid injections in 207 patients who had a total of 322 injections revealed an overall incidence of complication per injection at 9.6%. The most common complication was a nonpositional headache, with an incidence of 3.1% per injection. The second most common complication was increased back pain at the injection site in 2.4% of patients per injection. None of the complications required hospitalization, all were
Acknowledgements
The authors thank Carol Barragan, Pat Keenan, RN, Toni Milliken, RN, Nicole Belsanti, RRT, and George Gerlach, RRT, for their assistance.
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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
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Reprint requests to Kenneth P. Botwin, MD, Florida Spine Institute, 2250 Drew Street, Clearwater, FL 33765.
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