Complications of Cervical Transforaminal Epidural Steroid Injections

Abstract

Although cervical transforaminal epidural steroid injections are used in the treatment of radicular pain, there are a number of major and minor complications reported in the medical literature. These complications are limited to retrospective studies, retrospective survey studies, case reports, and data obtained from studies evaluating the benefit of cervical transforaminal steroid injections. Thus, the data are limited in value with regard to identifying evidence-based recommendations for future research. We aim to review and critically evaluate literature focusing on the incidence and clinical presentations of major complications associated with cervical transforaminal steroid injections. The goal of this review is to identify pertinent journal information that aids in the improvement in clinical care and guides future research by increasing the awareness of the potential major complications associated with this procedure and their presentations.

Ultrasound-guided versus computed tomography-controlled periradicular injections in the middle and lower cervical spine: a prospective randomized clinical trial

“…The reasons to permit injections via a transforaminal route rather than the interlaminar route are to deliver the injectate directly at the target nerve, periradicularly near the ganglion of spinal nerve, to ensure that the medication reaches the region of interest in maximum concentration [5]. Because of the anatomy of the cervical spine, cervical transforaminal injections may be technically challenging, and associated with potential morbidity and mortality [5].…”

“…Because of the anatomy of the cervical spine, cervical transforaminal injections may be technically challenging, and associated with potential morbidity and mortality [5]. Currently, procedures for cervical periradicular injections are preferentially radiographically controlled interventions [2,6].…”

Cervical Radiculopathy: A Review

“…The rate of complication ranged from 3% to 35% in these studies. There have been case reports of more catastrophic complications, including epidural hematomas that needed to be emergently decompressed and spinal cord infarction, particularly in the setting of severe central stenosis [40]. Due to these complications and the technical difficulty of the injection, physiatrists and pain management professionals are moving away from performing this procedure.…”

Current trends: Operative Strategy for the Management of Cervical Radiculopathy

“…[37] Anterior related spine surgery helps to restore cervical lordosis, spine stabilization, decompress the nerve roots and prevent the acceleration of changes at adjacent levels. From the posterior approach multilevel and laminoforaminotomy can be done to decompress cervical nerves causing radiculopathy but in cases of open posterior aggressive dissection of subperiosteal paraspinal muscles lead to post operative morbidity which can cause disability in 18-60 pc of patients [38,40].Some of the surgeon has demonstrated the cadaver studies on anterior lateral approaches and found it as safer method and less tissues damage to reach the target point . Surgical field is so small and narrow.…”