Cervical epidural steroid injections and spinal cord injuries

Schreiber, A; McDonald, Brian P.; Kia, Farid; Fried, Guy W.

doi:10.1016/j.spinee.2015.08.068

Cited by 24 publications

(17 citation statements)

References 8 publications

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“…Complications regarding CTFESI can range from minor to major; the latter includes spinal cord infarction, seizure, brain infarction, bleeding, quadriparesis, and death (13,14).…”

Section: Discussionmentioning

confidence: 99%

Neck movement during cervical transforaminal epidural injections and the position of the vertebral artery: an anatomical study

Altafulla

Yılmaz

Lachkar

et al. 2019

Acta Radiologica Open

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BackgroundCervical transforaminal epidural steroid injections (CTFESIs) are sometimes performed in patients with cervical radiculopathy secondary to nerve-root compression. Neck movements for patient positioning may include rotation, flexion, and extension. As physicians performing such procedures do not move the neck for fear of injuring the vertebral artery, we performed fluoroscopy and cadaveric dissection to analyze any movement of the vertebral artery during head movement and its relation to the foramina in the setting of CTFESI.PurposeTo determine cervical rotational positioning for optimized vertebral artery location in the setting of cervical transforaminal epidural steroid injections.Material and MethodsFour sides from two Caucasian whole cadavers (all fresh-frozen) were used. Using a guide wire and digital subtraction fluoroscopy, we evaluated the vertebral artery mimicking a CTFESI, then we removed the transverse processes and evaluated the vertebral artery by direct observation.ResultsAfter performing such maneuvers, no displacement of the vertebral artery was seen throughout its course from the C6 to the C2 intervertebral foramina. To our knowledge, this is the first anatomical observation of its kind that evaluates the position of the vertebral artery inside the foramina during movement of the neck.ConclusionSpecial caution should be given to the medial border of the intervertebral foramina when adjusting the target site and needle penetration for the injection. This is especially true for C6-C4 levels, whereas for the remaining upper vertebrae, the attention should be focused on the anterior aspect of the foramen. Since our study was centered on the vertebral artery, we do not discard the need for contrast injection and real-time digital subtraction fluoroscopy while performing the transforaminal epidural injection in order to prevent other vascular injuries.

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“…Complications regarding CTFESI can range from minor to major; the latter includes spinal cord infarction, seizure, brain infarction, bleeding, quadriparesis, and death (13,14).…”

Section: Discussionmentioning

confidence: 99%

Neck movement during cervical transforaminal epidural injections and the position of the vertebral artery: an anatomical study

Altafulla

Yılmaz

Lachkar

et al. 2019

Acta Radiologica Open

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“…6,7,11 Furthermore, improved spatial resolution may have prevented several of the published major complications, including the cases of pneumocephalus 16 and stroke with cortical blindness, 17 where there was evidence of inadvertent intrathecal and vascular penetration, respectively. Also of note is that many of the published major complications, including four cases of spinal cord infarct, [12][13][14][15] occurred with use of particulate steroid, as opposed to the non-particulate steroid solutions described in recent literature. 7,11 Whilst performed in a variety of radiology practices, there may remain some apprehension about performing CT-guided cervical nerve root injections outside of a large hospital centre due to the potential major complications reported mostly with the traditional X-ray fluoroscopic guided technique using particulate steroid and the assumption that the risk may be the same.…”

Section: Introductionmentioning

confidence: 97%

“…Furthermore, improved spatial resolution may have prevented several of the published major complications, including the cases of pneumocephalus and stroke with cortical blindness, where there was evidence of inadvertent intrathecal and vascular penetration, respectively. Also of note is that many of the published major complications, including four cases of spinal cord infarct, occurred with use of particulate steroid, as opposed to the non‐particulate steroid solutions described in recent literature …”

Section: Introductionmentioning

confidence: 99%

“…Although rare, significant or major neurovascular complications have been published in case reports, including spinal cord infarction, [12][13][14][15] pneumocephalus with loss of consciousness, 16 stroke with cortical blindness, 17 cerebellar and brainstem infarction, 18 vertebral artery dissection causing death, 19 and spinal cord injury due to intraparenchymal injection, epidural abscess, contusion and epidural haematoma. 15,20 A number of less significant or minor complications have been noted to more frequently occur, including vasovagal presyncope, pain at injection site, increased radicular pain, light headedness, increased spine pain, nausea, vomiting and non-specific headache. 6,7,[21][22][23] In Australia, local guidelines suggest that cervical nerve root injections may be performed under either CT or X-ray guidance.…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, cervical nerve root injections have been performed under X‐ray fluoroscopic guidance, using the bony landmarks of the cervical transverse processes and articular processes. Although rare, significant or major neurovascular complications have been published in case reports, including spinal cord infarction, pneumocephalus with loss of consciousness, stroke with cortical blindness, cerebellar and brainstem infarction, vertebral artery dissection causing death, and spinal cord injury due to intraparenchymal injection, epidural abscess, contusion and epidural haematoma . A number of less significant or minor complications have been noted to more frequently occur, including vasovagal presyncope, pain at injection site, increased radicular pain, light headedness, increased spine pain, nausea, vomiting and non‐specific headache …”

Section: Introductionmentioning

confidence: 99%

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Safety of CT‐guided cervical nerve root corticosteroid injections

2019

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Introduction Computed tomography‐guided cervical nerve root corticosteroid injections are a commonly performed procedure for cervical radiculopathy. There have been major complications such as spinal cord infarction and posterior circulation stroke reported mostly with X‐ray fluoroscopic‐guided methods, however, there is relatively little data on the safety of newer CT‐guided methods. The purpose of this study was to identify any major complications and evaluate the rate of minor complications from CT‐guided cervical nerve root corticosteroid injections performed in a tertiary public hospital. Methods Four hundred and three CT‐guided cervical nerve root injection procedures were identified over a period from July 2015 to January 2018 using the radiology information system (RIS) and data collected about the technique and any immediate complications. Patient follow‐up and delayed complications were then reviewed, either via outpatient clinic records or telephone consultation. Results Two hundred and eighty‐six procedures were performed by radiology registrars or fellows, and 117 by radiologists, most commonly via an anterolateral approach and injecting 4 mg (in 1 mL) of dexamethasone. Follow‐up data were obtained for all 403 procedures and identified 16 minor complications, but no major neurovascular complications. Conclusion The overall recorded rate of minor complications with CT‐guided nerve root injection was 4.0% with no major neurovascular complications, suggesting that CT‐guided transforaminal cervical corticosteroid injection is a safe procedure.

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Complications of Cervical Epidural Steroid Injection

Nelson

Benzon

2022

Complications of Pain‐Relieving Procedures

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Cervical epidural steroid injections and spinal cord injuries

Cited by 24 publications

References 8 publications

Neck movement during cervical transforaminal epidural injections and the position of the vertebral artery: an anatomical study

Neck movement during cervical transforaminal epidural injections and the position of the vertebral artery: an anatomical study

Safety of CT‐guided cervical nerve root corticosteroid injections

Complications of Cervical Epidural Steroid Injection

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