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Current Pain and Headache Reports
Published in: Current Pain and Headache Reports 5/2015

01-05-2015 | Anesthetic Techniques in Pain Management (D Wang, Section Editor)

Neurological Complications Associated with Epidural Steroid Injections

Authors: Laxmaiah Manchikanti, Joshua A. Hirsch

Published in: Current Pain and Headache Reports | Issue 5/2015

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Abstract

Multiple case reports of neurological complications resulting from intraarterial injection of corticosteroids have led the Food and Drug Administration (FDA) to issue a warning, requiring label changes, warning of serious neurological events, some resulting in death. The FDA has identified 131 cases of neurological adverse events, including 41 cases of arachnoiditis. A review of the literature reveals an overwhelming proportion of the complications are related to transforaminal epidural injections, of which cervical transforaminal epidural injections constituted the majority of neurological complications. Utilization data of epidural injections in the Medicare population revealed that cervical transforaminal epidural injections constitute only 2.4 % of total epidural injections and <5 % of all transforaminal epidural injections. Multiple theories have been proposed as the cause of neurological injury including particulate steroid, arterial intimal flaps, arterial dissection, dislodgement of plaque causing embolism, arterial muscle spasm, and embolism of a fresh thrombus following disruption of the intima.
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Metadata
Title
Neurological Complications Associated with Epidural Steroid Injections
Authors
Laxmaiah Manchikanti
Joshua A. Hirsch
Publication date
01-05-2015
Publisher
Springer US
Published in
Current Pain and Headache Reports / Issue 5/2015
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-015-0482-3