The complications of transforaminal lumbar epidural steroid injections

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2011-06, Vol.36 (13), p.E819-E824
• Main Authors: Karaman, Haktan, Kavak, Gönül Olmez, Tüfek, Adnan, Yldrm, Zeynep Baysal
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Female; Fluoroscopy; Humans; Injections, Epidural - adverse effects; Intervertebral Disc Displacement - drug therapy; Lumbar Vertebrae - diagnostic imaging; Male; Middle Aged; Prospective Studies; Radiography, Interventional; Risk Assessment; Risk Factors; Steroids - administration & dosage; Syncope, Vasovagal - etiology; Treatment Outcome; Turkey; Vascular System Injuries - etiology; Young Adult
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e3181f32bae

A prospective observational study. In this study, we aimed to investigate the major and minor complications of transforaminal lumbar epidural steroid injections guided by fluoroscopy and the incidence of vascular penetration encountered during this procedure. Epidural steroid administration is one of the treatment options for lumbar disc hernia accompanied by radiculopathy. This method, initially applied by blind interlaminar technique, has generally been performed by fluoroscopically guided transforaminal method now. The complications of this method cause to a serious concern. The complications of this intervention have been reported by either mostly retrospective studies or case reports until now. Prospective studies with large patient series are needed to determine the types and incidences of the complications. In this study carried out for more than 5 years, major and minor complications of transforaminal lumbar epidural steroid injections were investigated prospectively. All of the interventions were performed under fluoroscopic guidance by the same physician using a standardized method. A follow-up was made once in the third week. The complications encountered during the procedure and in the third week were prospectively recorded. In addition, the incidence of vascular penetration that is potentially hazardous is included in the study. A total of 562 patients were performed 1305 times transforaminal lumbar epidural steroid. The overall incidence of vascular penetration encountered was 7.4%. Although major complications were not seen, the total rate of all minor complications was 11.5%. Whereas all of the minor complications were transient, the most frequent minor complication was vasovagal reaction (8.7%). On the basis of the results of this study in which only minor complications were encountered, it can be said that the frequency of major complications is pretty rare in transforaminal lumbar epidural steroid injections in expert hands and in the conditions in which safety precautions are taken.