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European Spine Journal
Published in: European Spine Journal 5/2020

Open Access 01-05-2020 | Dexamethasone | Original Article

The safety and efficiency of performing cervical transforaminal epidural steroid injections under fluoroscopic control on an ambulatory/outpatient basis

Authors: Keith Bush, Ramin Mandegaran, Elizabeth Robinson, Ali Zavareh

Published in: European Spine Journal | Issue 5/2020

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Abstract

Purpose

Cervical transforaminal epidural steroid injections (CTFESIs) have become an increasingly utilised means of treating radicular pain over recent decades, although a number of reports have brought their safety into question. Much of this has been attributed to the use of particulate steroids and the theoretical risk of embolic complications with inadvertent intra-arterial injection. This study documents the complications encountered at our centre when performing CTFESI over a more than 10-year study period with predominant use of particulate steroid. Our procedural technique is also described. This study aims to highlight the importance of operator technique first and foremost and how, with safe and reproducible technique that confidently avoids intra-arterial injection, CTFESI can be performed safely irrespective of the choice of steroid.

Methods

All patients undergoing CTFESI between January 2008 and August 2018 at our centre were prospectively recruited to the study, documenting total number of injections/procedures per patient, presence of/description of complications and severity and type of steroid administered.

Results

Five hundred and twenty-seven patients underwent 1047 procedures (1753 individual cervical levels injected) over the study period: 1011 procedures performed with particulate steroid (triamcinolone acetonide) and 36 performed with non-particulate (dexamethasone). Only six complications were encountered, all spontaneously self-resolving without intervention and considered minor (grade 1).

Conclusions

With fastidious safe technique, CTFESI can be safe, efficacious and cost-effectively administered on an outpatient basis. Predominant use of particulate steroids did not lead to any significant complications.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.
Appendix
Available only for authorised users
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Metadata
Title
The safety and efficiency of performing cervical transforaminal epidural steroid injections under fluoroscopic control on an ambulatory/outpatient basis
Authors
Keith Bush
Ramin Mandegaran
Elizabeth Robinson
Ali Zavareh
Publication date
01-05-2020
Publisher
Springer Berlin Heidelberg
Keyword
Dexamethasone
Published in
European Spine Journal / Issue 5/2020
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-019-06147-2

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