Safety of cervical transforaminal epidural steroid injections

Interventional Pain Medicine, 2024 · DOI: https://doi.org/10.1016/j.inpm.2024.100420 · Published: June 5, 2024

Simple Explanation

This study evaluates the safety of cervical transforaminal epidural steroid injections (TFESIs) using non-particulate steroids, addressing concerns raised by a 2014 FDA warning about neurological adverse events. The research involved reviewing cervical TFESIs performed between 2004 and 2021, during which non-particulate steroids became more commonly used, and querying physicians about any catastrophic complications. The findings suggest that cervical TFESIs, when performed with non-particulate steroids, are a safe procedure, supporting recommendations from medical societies.

Study Duration

2004 to 2021

Participants

6241 cervical TFESIs, subset analysis of 200 consecutive cervical TFESIs

Evidence Level

Not specified

Key Findings

1
No catastrophic complications (spinal cord injury, stroke, death or other) were reported in 6241 cervical TFESIs performed between 2004 and 2021.
2
In a subset analysis of 200 consecutive cervical TFESIs, 85.5% of patients reported a decrease in pain, with an average pain score drop of 3.7 points.
3
A small percentage of patients (3.5%) experienced a transient increase in pain, and minor complications such as insomnia, headache, and elevated glucose levels were reported in isolated cases.

Research Summary

This retrospective study investigates the safety of cervical transforaminal epidural steroid injections (TFESIs) using non-particulate steroids over a 17-year period at an academic institution. The study found no catastrophic complications among 6241 cervical TFESIs and a high rate of pain reduction in a subset analysis, supporting the safety of the procedure when non-particulate steroids are used. The authors conclude that cervical TFESIs with non-particulate steroids are a safe and viable option for managing neck and cervical radicular pain, aligning with consensus opinions from medical societies.

Practical Implications

Clinical Practice

Supports the use of cervical TFESIs with non-particulate steroids as a safe option for managing neck pain.

Risk Management

Reinforces the importance of using non-particulate steroids to avoid severe neurological complications.

Patient Education

Provides data to reassure patients about the safety of cervical TFESIs when performed with appropriate techniques and materials.

Study Limitations

1
Retrospective review of electronic medical records.
2
Lack of J codes makes it impossible to verify non-particulate steroid use in all cervical TFESIs.
3
Reliance on physician recall for reporting catastrophic complications.

Your Feedback

Was this summary helpful?

Back to Neurology