Epidural steroid injections: an updated review on recent trends in safety and complications

Papers of special note have been highlighted as: • of interest; •• of considerable interest:

References

• 1 Hoy D, March L, Brooks P et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann. Rheum. Dis. 73(6), 968–974 (2014).
  MedlineGoogle Scholar
• 2 Hoy D, March L, Woolf A et al. The global burden of neck pain: estimates from the global burden of disease 2010 study. Ann. Rheum. Dis. 73(7), 1309–1315 (2014).
  MedlineGoogle Scholar
• 3 Martin BI, Deyo RA, Mirza SK et al. Expenditures and health status among adults with back and neck problems. JAMA 299(6), 656–664 (2008).
  Medline CASGoogle Scholar
• 4 Hoy D, Bain C, Williams G et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 64(6), 2028–2037 (2012).
  MedlineGoogle Scholar
• 5 Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur. Spine J. 15(6), 834–848 (2006).
  MedlineGoogle Scholar
• 6 Hogg-Johnson S, van der Velde G, Carroll LJ et al. The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila. Pa. 1976) 33(4 Suppl.), S39–S51 (2008).
  MedlineGoogle Scholar
• 7 da C, Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ 184(11), E613–E624 (2012).
  MedlineGoogle Scholar
• 8 Vasseljen O, Woodhouse A, Bjørngaard JH, Leivseth L. Natural course of acute neck and low back pain in the general population: the HUNT study. Pain 154(8), 1237–1244 (2013).
  MedlineGoogle Scholar
• 9 Vos CJ, Verhagen AP, Passchier J, Koes BW. Clinical course and prognostic factors in acute neck pain: an inception cohort study in general practice. Pain Med. 9(5), 572–580 (2008).
  MedlineGoogle Scholar
• 10 Cohen, SP. Epidemiology, diagnosis and treatment of neck pain. Mayo Clin. Proc. (2014)(In Press).
  MedlineGoogle Scholar
• 11 Beith ID, Kemp A, Kenyon J, Prout M, Chestnut TJ. Identifying neuropathic back and leg pain: a cross-sectional study. Pain 152(7), 1511–1516 (2011).
  MedlineGoogle Scholar
• 12 El Sissi W, Arnaout A, Chaarani MW et al. Prevalence of neuropathic pain among patients with chronic low-back pain in the Arabian Gulf Region assessed using the leeds assessment of neuropathic symptoms and signs pain scale. J. Int. Med. Res. 38(6), 2135–2145 (2010).
  Medline CASGoogle Scholar
• 13 Salemi G, Savettieri G, Meneghini F et al. Prevalence of cervical spondylotic radiculopathy: a door-to-door survey in a Sicilian municipality. Acta Neurol. Scand. 93(2–3), 184–188 (1996).
  Medline CASGoogle Scholar
• 14 Schoenfeld AJ, George AA, Bader JO et al. Incidence and epidemiology of cervical radiculopathy in the United States military: 2000 to 2009. J. Spinal Disord. Tech. 25(1), 17–22 (2012).
  MedlineGoogle Scholar
• 15 Radhakrishnan K, Litchy WJ, O'Fallon WM et al. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain 117(Pt 2), 325–335 (1994).
  MedlineGoogle Scholar
• 16 Kleinman N, Patel AA, Benson C, Macario A, Kim M, Biondi DM. Economic burden of back and neck pain: effect of a neuropathic component. Popul. Health Manag. 17(4), 224–232 (2014).
  MedlineGoogle Scholar
• 17 Mehra M, Hill K, Nicholl D, Schadrack J. The burden of chronic low back pain with and without a neuropathic component: a healthcare resource use and cost analysis. J. Med. Econ. 15(2), 245–252 (2012).
  MedlineGoogle Scholar
• 18 Manchikanti L, Pampati V, Falco FJ, Hirsch JA. Growth of spinal interventional pain management techniques: analysis of utilization trends and Medicare expenditures 2000 to 2008. Spine (Phila. Pa. 1976) 38(2), 157–168 (2013).• The substantial increase in interventional pain procedures is described in this review of Medicare expenditures.
  MedlineGoogle Scholar
• 19 Hoeft MA, Rathmell JP, Monsey RD, Fonda BJ. Cervical transforaminal injection and the radicular artery: variation in anatomical location within the cervical intervertebral foramina. Reg. Anesth. Pain Med. 31(3), 270–274 (2006).
  MedlineGoogle Scholar
• 20 Nijenhuis RJ, Leiner T, Cornips EM et al. Spinal cord feeding arteries at MR angiography for thoracoscopic spinal surgery: feasibility study and implications for surgical approach. Radiology 233(2), 541–547 (2004).
  MedlineGoogle Scholar
• 21 Houten JK, Errico TJ. Paraplegia after lumbosacral nerve root block: report of three cases. Spine J. 2(1), 70–75 (2002).
  MedlineGoogle Scholar
• 22 MacLean CA, Bachman DT. Documented arterial gas embolism after spinal epidural injection. Ann. Emerg. Med. 38(5), 592–595 (2001).
  Medline CASGoogle Scholar
• 23 Aldrete JA, Mushin AU, Zapata JC, Ghaly R. Skin to cervical epidural space distances as read from magnetic resonance imaging films: consideration of the “hump pad.” J. Clin. Anesth. 10(4), 309–313 (1998).
  Medline CASGoogle Scholar
• 24 Moon JY, Lee PB, Nahm FS, Kim YC, Choi JB. Cervical epidural pressure measurement: comparison in the prone and sitting positions. Anesthesiology 113(3), 666–671 (2010).
  MedlineGoogle Scholar
• 25 Gil NS, Lee JH, Yoon SZ, Jeon Y, Lim YJ, Bahk JH. Comparison of thoracic epidural pressure in the sitting and lateral decubitus positions. Anesthesiology 109(1), 67–71 (2008).
  MedlineGoogle Scholar
• 26 Stojanovic MP, Vu TN, Caneris O, Slezak J, Cohen SP, Sang CN. The role of fluoroscopy in cervical epidural steroid injections: an analysis of contrast dispersal patterns. Spine (Phila. Pa. 1976) 27(5), 509–514 (2002).
  MedlineGoogle Scholar
• 27 Liu SS, Melmed AP, Klos JW, Innis CA. Prospective experience with a 20-gauge Tuohy needle for lumbar epidural steroid injections: is confirmation with fluoroscopy necessary? Reg. Anesth. Pain Med. 26(2), 143–146 (2001).
  Medline CASGoogle Scholar
• 28 Barham G, Hilton A. Caudal epidurals: the accuracy of blind needle placement and the value of a confirmatory epidurogram. Eur. Spine J. 19(9), 1479–83 (2010).
  MedlineGoogle Scholar
• 29 Stitz MY, Sommer HM. Accuracy of blind versus fluoroscopically guided caudal epidural injection. Spine (Phila. Pa. 1976) 24(13), 1371–1376 (1999).
  Medline CASGoogle Scholar
• 30 Benzon HT, Chew TL, McCarthy RJ, Benzon HA, Walega DR. Comparison of the particle sizes of different steroids and the effect of dilution: a review of the relative neurotoxicities of the steroids. Anesthesiology 106(2), 331–338 (2007).• Differences in particulate and nonparticulate steroids were firmly established with publication of this examination of steroid particle sizes.
  Medline CASGoogle Scholar
• 31 Derby R, Lee SH, Date ES, Lee JH, Lee CH. Size and aggregation of corticosteroids used for epidural injections. Pain Med. 9(2), 227–234 (2008).
  MedlineGoogle Scholar
• 32 Dreyfuss P, Baker R, Bogduk N. Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain. Pain Med. 7(3), 237–242 (2006).
  MedlineGoogle Scholar
• 33 Park CH, Lee SH, Kim BI. Comparison of the effectiveness of lumbar transforaminal epidural injection with particulate and nonparticulate corticosteroids in lumbar radiating pain. Pain Med. 11(11), 1654–1658 (2010).
  MedlineGoogle Scholar
• 34 Kim D, Brown J. Efficacy and safety of lumbar epidural dexamethasone versus methylprednisolone in the treatment of lumbar radiculopathy: a comparison of soluble versus particulate steroids. Clin. J. Pain 27(6), 518–522 (2011).
  MedlineGoogle Scholar
• 35 Datta R, Upadhyay BK. A randomized clinical trial of three difference steroid agents for treatment of low backache through the caudal route. Armed Forces Med. J. India 67(1), 25–33 (2011).
  Google Scholar
• 36 Drazen JM, Curfman GD, Baden LR, Morrissey S. Compounding errors. N. Engl. J. Med. 367(25), 2436–2437 (2012).
  Medline CASGoogle Scholar
• 37 Benzon HT. Compounded steroids for epidural injections: what are the issues? Anesth. Analg. 117(2), 523–526 (2013).
  MedlineGoogle Scholar
• 38 Centers for Disease Control and Prevention. Exophiala infection from contaminated injectable steroids prepared by a compounding pharmacy. Morb. Mortal. Wkly Rep. 51(49), 1109–1112 (2002).
  MedlineGoogle Scholar
• 39 Kainer MA, Reagan DR, Nguyen DB et al. Fungal infections associated with contaminated methylprednisolone in Tennessee. N. Engl. J. Med. 367(23), 2194–2203 (2012).•• Preliminary results from the 2012–2013 outbreak of fungal meningitis detail the consequences of injecting steroids that were contaminated by compounding pharmacies.
  Medline CASGoogle Scholar
• 40 Outterson K. Regulating compounding pharmacies after NECC. N. Engl. J. Med. 367(21), 1969–1972 (2012).
  Medline CASGoogle Scholar
• 41 De Vries F, Bracke M, Leufkens HGM et al. Fracture risk with intermittent high dose oral glucocorticoid therapy. Arthritis Rheum. 56(1), 208–214 (2007).
  Medline CASGoogle Scholar
• 42 Mitra R. Adverse effects of corticosteroids on bone metabolism: a review. PMR 3(5), 466–471 (2011).
  MedlineGoogle Scholar
• 43 Steinbuch M, Youket TE, Cohen S. Oral glucocorticoid use is associated with an increased risk of fracture. Osteoporos Int. 15(4), 323–328 (2004).
  Medline CASGoogle Scholar
• 44 Al-Shoha A, Rao DS, Schilling J, Peterson E, Mandel S. Effect of epidural steroid injection on bone mineral density and markers of bone turnover in postmenopausal women. Spine (Phila. Pa. 1976) 37(25), E1567–E1571 (2012).
  MedlineGoogle Scholar
• 45 Kim S, Hwang B. Relationship between bone mineral density and the frequent administration of epidural steroid injections in postmenopausal women with low back pain. Pain Res. Manag. 19(1), 30–34 (2014).
  MedlineGoogle Scholar
• 46 Kang SS, Hwang BM, Son H, Cheong IY, Lee SJ, Chung TY. Changes in bone mineral density in postmenopausal women treated with epidural steroid injections for lower back pain. Pain Physician 15(3), 229–236 (2012).
  MedlineGoogle Scholar
• 47 Yi Y, Hwang B, Son H, Cheong IY. Low bone mineral density, but not epidural steroid injection, is associated with fracture in postmenopausal women with low back pain. Pain Physician 15(6), 441–449 (2012).
  MedlineGoogle Scholar
• 48 Mandel S, Schilling J, Peterson E, Rao DS, Sanders W. A retrospective analysis of vertebral body fractures following epidural steroid injections. J. Bone Joint Surg. Am. 95(11), 961–964 (2013).
  MedlineGoogle Scholar
• 49 Friedly JL, Comstock BA, Turner JA et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N. Engl. J. Med. 371(1), 11–21 (2014).
  MedlineGoogle Scholar
• 50 Lansang MC, Farmer T, Kennedy L. Diagnosing the unrecognized systemic absorption of intra-articular and epidural steroid injections. Endocr. Pract. 15(3), 225–228 (2009).
  MedlineGoogle Scholar
• 51 Tuel SM, Meythaler JM, Cross LL. Cushing's syndrome from epidural methylprednisolone. Pain 40(1), 81–84 (1990).
  Medline CASGoogle Scholar
• 52 Horani MH, Silverberg AB. Secondary Cushing's syndrome after a single epidural injection of a corticosteroid. Endocr. Pract. 11(6), 408–410 (2005).
  MedlineGoogle Scholar
• 53 Fessler D, Beach J, Keel J, Stead W. Iatrogenic hypercortisolism complicating triamcinolone acetonide injections in patients with HIV on ritonavir-boosted protease inhibitors. Pain Physician 15(6), 489–493 (2012).
  MedlineGoogle Scholar
• 54 Sadarangani S, Berg ML, Mauck W, Rizza S. Iatrogenic cushing syndrome secondary to ritonavir-epidural triamcinolone interaction: an illustrative case and review. Interdiscip. Perspect. Infect. Dis. 849432 (2014).
  MedlineGoogle Scholar
• 55 Kay J, Findling JW, Raff H. Epidural triamcinolone suppresses the pituitary-adrenal axis in human subjects. Anesth. Analg. 79(3), 501–505 (1994).
  Medline CASGoogle Scholar
• 56 Leary J, Swislocki A. Hypothalamic-pituitary-adrenal suppression and iatrogenic cushing's syndrome as a complication of epidural steroid injections. Case Rep. Endocrinol. 2013, 617042 (2013).
  MedlineGoogle Scholar
• 57 Gensler LS. Glucocorticoids: complications to anticipate and prevent. Neurohospitalist 3(2), 92–97 (2013).
  MedlineGoogle Scholar
• 58 Hooten WM, Mizerak A, Carns PE, Huntoon MA. Discitis after lumbar epidural corticosteroid injection: a case report and analysis of the case report literature. Pain Med. 7(1), 46–51 (2006).
  MedlineGoogle Scholar
• 59 Cansever T, Kabatas S, Civelek et al. Transforaminal epidural steroid injection via a preganglionic approach for the treatment of lumbar radicular pain. Turk. Neurosurg. 22(2), 183–188 (2012).
  MedlineGoogle Scholar
• 60 Centers for Disease Control and Prevention. Recommendations of the Advisory Committee on Immunization Practices (ACIP): use of vaccines and immune globulins in persons with altered immunocompetence. MMWR 42, RR-4 (1993).
  Google Scholar
• 61 Even JL, Crosby CG, Song Y et al. Effects of epidural steroid injections on blood glucose levels in patients with diabetes mellitus. Spine (Phila. Pa. 1976) 37(1), E46–E50 (2012).
  MedlineGoogle Scholar
• 62 Gonzalez P, Laker SR, Sullivan W, Harwood JE, Akuthota V. The effects of epidural betamethasone on blood glucose in patients with diabetes mellitus. PMR 1(4), 340–345 (2009).
  MedlineGoogle Scholar
• 63 Younes M, Neffati F, Touzi M et al. Systemic effects of epidural and intra-articular glucocorticoid injections in diabetic and non-diabetic patients. Joint Bone Spine 74(5), 472–476 (2007).
  Medline CASGoogle Scholar
• 64 Kim WH, Sim WS, Shin BS et al. Effects of two different doses of epidural steroid on blood glucose levels and pain control in patients with diabetes mellitus. Pain Physician 16(6), 557–568 (2013).
  MedlineGoogle Scholar
• 65 Trentman TL, Rosenfeld DM, Seamans DP, Hentz JG, Stanek JP. Vasovagal reactions and other complications of cervical vs. lumbar translaminar epidural steroid injections. Pain Pract. 9(1), 59–64 (2009).
  MedlineGoogle Scholar
• 66 Kennedy DJ, Schneider B, Casey E et al. Vasovagal rates in flouroscopically guided interventional procedures: a study of over 8,000 injections. Pain Med. 14(12), 1854–1859 (2013).
  MedlineGoogle Scholar
• 67 Manchikanti L, Malla Y, Wargo BW, Cash KA, Pampati V, Fellows B. A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections. Pain Physician 15(2), 131–140 (2012).
  MedlineGoogle Scholar
• 68 Davignon KR, Dennehy KC. Update on postdural puncture headache. Int. Anesthesiol. Clin. 40(4), 89–102 (2002).
  MedlineGoogle Scholar
• 69 Cohen SP, Bicket MC, Jamison D, Wilkinson I, Rathmell JP. Epidural steroids: a comprehensive, evidence-based review. Reg. Anesth. Pain Med. 38(3), 175–200 (2013).•• This evidence-based review systematically provides a thorough examination of the literature related to epidural steroid injections, with a particular emphasis on the influence of approach and region of epidural steroid delivery, the type and dose of injectate and factors associated with treatment success.
  Medline CASGoogle Scholar
• 70 Verdun AV, Cohen SP, Williams BS et al. Pneumocephalus after lumbar epidural steroid injection: a case report and review of the literature. Anesth. Analg. Case Reports 3(1), 9–13 (2014).
  MedlineGoogle Scholar
• 71 Sweni S, Senthilkumaran S, Balamurugan N, Thirumalaikolundusubramanian P. Tension pneumocephalus: a case report with review of literature. Emerg. Radiol. 20(6), 573–578 (2013).
  MedlineGoogle Scholar
• 72 McGrath JM, Schaefer MP, Malkamaki DM. Incidence and characteristics of complications from epidural steroid injections. Pain Med. 12(5), 726–731 (2011).
  MedlineGoogle Scholar
• 73 Everett CR, Baskin MN, Speech D, Novoseletsky D, Patel R. Flushing as a side effect following lumbar transforaminal epidural steroid injection. Pain Physician 7(4), 427–429 (2004).
  MedlineGoogle Scholar
• 74 Abbasi A, Roque-Dang CM, Malhotra G. Persistent hiccups after interventional pain procedures: a case series and review. PMR 4(2), 144–151 (2012).
  MedlineGoogle Scholar
• 75 Özcan U, Şahin Ş, Gurbet A, Türker G, Özgür M, Çelebi S. Comparison of blunt and sharp needles for transforaminal epidural steroid injections. Agri 24(2), 85–89 (2012).
  MedlineGoogle Scholar
• 76 Candido KD, Katz JA, Chinthagada M, McCarthy RA, Knezevic NN. Incidence of intradiscal injection during lumbar fluoroscopically guided transforaminal and interlaminar epidural steroid injections. Anesth. Analg. 110(5), 1464–1467 (2010).
  MedlineGoogle Scholar
• 77 Plastaras CT, Casey E, Goodman BS, Chou L, Roth D, Rittenberg J. Inadvertent intradiscal contrast flow during lumbar transforaminal epidural steroid injections: a case series examining the prevalence of intradiscal injection as well as potential associated factors and adverse events. Pain Med. 11(12), 1765–1773 (2010).
  MedlineGoogle Scholar
• 78 Hong JH, Lee SM, Bae JH. Analysis of inadvertent intradiscal injections during lumbar transforaminal epidural injection. Korean J. Pain 27(2), 168–173 (2014).
  MedlineGoogle Scholar
• 79 Banerjee AK, Okun S, Edwards IR et al. Patient-reported outcome measures in safety event reporting: PROSPER Consortium guidance. Drug Saf. 36(12), 1129–1149 (2013).
  MedlineGoogle Scholar
• 80 Baker R, Dreyfuss P, Mercer S, Bogduk N. Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury. Pain 103(1–2), 211–215 (2003).
  MedlineGoogle Scholar
• 81 Wald JT, Maus TP, Deske JR et al. Safety and efficacy of CT-guided transforaminal cervical epidural steroid injections using a posterior approach. AJNR Am. J. Neuroradiol.. 33(3), 415–419 (2012).
  Medline CASGoogle Scholar
• 82 Cohen SP, Maine DN, Shockey SM, Kudchadkar S, Griffith S. Inadvertent disk injection during transforaminal epidural steroid injection: steps for prevention and management. Pain Med. 9(6), 688–694 (2008).
  MedlineGoogle Scholar
• 83 Lejeune JP, Hladky JP, Cotten A, Vinchon M, Christiaens JL. Foraminal lumbar disc herniation. Experience with 83 patients. Spine (Phila Pa 1976) 19(17), 1905–1908 (1994).
  Medline CASGoogle Scholar
• 84 Centers for Disease Control and Prevention. Multistate fungal meningitis outbreak investigation. www.cdc.gov/hai/outbreaks/meningitis-map-large.html.
  Google Scholar
• 85 Chiller TM, Roy M, Nguyen D et al. Clinical findings for fungal infections caused by methylprednisolone injections. N. Engl. J. Med. 369(17), 1610–1619 (2013).• The early clinical outcomes of the patients exposed to contaminated steroid products through spinal injections are described.
  Medline CASGoogle Scholar
• 86 Fitzgibbon DR, Posner KL, Domino KB, Caplan RA, Lee LA, Cheney FW. Chronic pain management: American Society of Anesthesiologists Closed Claims Project. Anesthesiology 100(1), 98–105 (2004).• Complications associated with epidural steroid injections accounted for 40% of all chronic pain management claims in the ASA Closed Claims Project.
  MedlineGoogle Scholar
• 87 Tang HJ, Lin HJ, Liu YC, Li CM. Spinal epidural abscess-experience with 46 patients and evaluation of prognostic factors. J. Infect. 45(2), 76–81 (2002).
  MedlineGoogle Scholar
• 88 Hooten WM, Mizerak A, Carns PE, Huntoon MA. Discitis after lumbar epidural corticosteroid injection: a case report and analysis of the case report literature. Pain Med. 7(1), 46–51 (2006).
  MedlineGoogle Scholar
• 89 Davis K, Prater A, Fluker SA, Klein R. A difficult case to swallow: herpes esophagitis after epidural steroid injection. Am. J. Ther. 21(1), e9–e14 (2014).
  MedlineGoogle Scholar
• 90 Wilkinson I, Cohen SP. Epidural steroids for spinal pain and radiculopathy: a narrative, evidence-based review. Curr. Opin. Anaesthesiol. 26(5), 562–572 (2013).
  Medline CASGoogle Scholar
• 91 Stoll A, Sanchez M. Epidural hematoma after epidural block: implications for its use in pain management. Surg. Neurol. 57(4), 235–240 (2002).
  MedlineGoogle Scholar
• 92 Horlocker TT, Wedel DJ, Rowlingson JC et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine evidence-based guidelines. Reg. Anesth. Pain Med. 35(1), 64–101 (2010).
  Medline CASGoogle Scholar
• 93 Horlocker TT. Regional anaesthesia in the patient receiving antithrombotic and antiplatelet therapy. Br. J. Anaesth. 107(Suppl. 1), i96–i106 (2011).
  Medline CASGoogle Scholar
• 94 Rathmell J, Michna E, Fitzgibbon D et al. Injury and liability associated with cervical procedures for chronic pain. Anesthesiology 114(4), 918–926 (2011).
  MedlineGoogle Scholar
• 95 Xu R, Bydon M, Gokaslan ZL, Wolinsky JP, Witham TF, Bydon A. Epidural steroid injection resulting in epidural hematoma in a patient despite strict adherence to anticoagulation guidelines. J. Neurosurg. Spine 11(3), 358–364 (2009).
  MedlineGoogle Scholar
• 96 Manchikanti L, Benyamin R, Swicegood J et al. Assessment of practice patterns of perioperative management of antiplatelet and anticoagulant therapy in interventional pain management. Pain Physician 15(6), E955–E968 (2012).
  MedlineGoogle Scholar
• 97 Epstein NE. The risks of epidural and transforaminal steroid injections in the spine: commentary and a comprehensive review of the literature. Surg. Neurol. Int. 4(Suppl. 2), S74–S93 (2013).
  MedlineGoogle Scholar
• 98 Scanlon GC, Moeller-Bertram T, Romanowsky SM et al. Cervical transforaminal epidural steroid injections. More dangerous than we think? Spine (Phila. Pa. 1976) 32(11), 1249–1256 (2007).
  MedlineGoogle Scholar
• 99 Atluri S, Glaser SE, Shah RV, Sudarshan G. Needle position analysis in cases of paralysis from transforaminal epidurals: consider alternative approaches to traditional technique. Pain Physician 16(4), 321–34 (2013).
  MedlineGoogle Scholar
• 100 Glaser SE, Falco F. Paraplegia following a thoracolumbar transforaminal epidural steroid injection. Pain Physician 8(3), 309–14 (2005).
  MedlineGoogle Scholar
• 101 Ludwig MA, Burns SP. Spinal cord infarction following cervical transforaminal epidural injection: a case report. Spine (Phila. Pa. 1976) 30(10), E266–E268 (2005).
  MedlineGoogle Scholar
• 102 Food and Drug Adminstration. FDA Briefing Information for the November 24–25, 2014 Meeting of the Anesthetic and Analgesic Drug Products Advisory Committee. www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndAnalgesicDrugProductsAdvisoryCommittee/ucm422691.htm.
  Google Scholar
• 103 McMillan MR, Crumpton C. Cortical blindness and neurologic injury complicating cervical transforaminal injection for cervical radiculopathy. Anesthesiology 99(2), 509–511 (2003).
  MedlineGoogle Scholar
• 104 Tiso RL, Cutler T, Catania JA et al. Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J. 4(4), 468–474 (2004).
  MedlineGoogle Scholar
• 105 Windsor RE, Storm S, Sugar R et al. Cervical transforaminal injection: review of the literature, complications, and a suggested technique. Pain Physician 6(4), 457–465 (2003).
  MedlineGoogle Scholar
• 106 Beckman WA, Mendez RJ, Paine GF et al. Cerebellar herniation after cervical transforaminal epidural injection. Reg. Anesth. Pain Med. 31(3), 282–285 (2006).
  MedlineGoogle Scholar
• 107 Ziai WC, Ardelt AA, Llinas RH. Brainstem stroke following uncomplicated cervical epidural steroid injection. Arch. Neurol. 63(11), 1643–1646 (2006).
  MedlineGoogle Scholar
• 108 Muro K, O'Shaughnessy B, Ganju A. Infarction of the cervical spinal cord following multilevel transforaminal epidural steroid injection: case report and review of the literature. J. Spinal Cord Med. 30(4), 385–388 (2007).
  MedlineGoogle Scholar
• 109 Rozin L, Rozin R, Koehler SA et al. Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery. Am. J. Forensic Med. Pathol. 24(4), 351–355 (2003).
  MedlineGoogle Scholar
• 110 Wallace MA, Fukui MB, Williams RL et al. Complications of cervical selective nerve root blocks performed with fluoroscopic guidance. AJR Am. J. Roentgenol. 188(5), 1218–1221 (2007).
  MedlineGoogle Scholar
• 111 Okubadejo GO, Talcott MR, Schmidt RE et al. Perils of intravascular methylprednisolone injection into the vertebral artery. An animal study. J. Bone Joint Surg. Am. 90(9), 1932–1938 (2008).
  MedlineGoogle Scholar
• 112 Dawley JD, Moeller-Bertram T, Wallace MS, Patel PM. Intra-arterial injection in the rat brain: evaluation of steroids used for transforaminal epidurals. Spine (Phila. Pa. 1976) 34(16), 1638–1643 (2009).
  MedlineGoogle Scholar
• 113 Kraemer J, Ludwig J, Bickert U, Owczarek V, Traupe M. Lumbar epidural perineural injection: a new technique. Eur. Spine J. 6(5), 357–61 (1997).
  Medline CASGoogle Scholar
• 114 Furman MB, Giovanniello MT, O'Brien EM. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine (Phila. Pa. 1976) 28(1), 21–25 (2003).
  MedlineGoogle Scholar
• 115 Hong JH, Huh B, Shin HH. Comparison between digital subtraction angiography and real-time fluoroscopy to detect intravascular injection during lumbar transforaminal epidural injections. Reg. Anesth. Pain Med. 39(4), 329–332 (2014).
  MedlineGoogle Scholar
• 116 El Abd OH, Amadera JE, Pimentel DC, Pimentel TS. Intravascular flow detection during transforaminal epidural injections: a prospective assessment. Pain Physician 17(1), 21–27 (2014).
  MedlineGoogle Scholar
• 117 Kozlov N, Benzon HT, Malik K. Epidural steroid injections: update on efficacy, safety, and newer medications for injection. Minerva Anestesiol. (2014) (Epub ahead of print).
  MedlineGoogle Scholar
• 118 Wybier M, Gaudart S, Petrover D, Houdart E, Laredo JD. Paraplegia complicating selective steroid injections of the lumbar spine. Report of five cases and review of the literature. Eur. Radiol. 20(1), 181–189 (2010).
  MedlineGoogle Scholar
• 119 Chang Chien GC, Candido KD, Knezevic NN. Digital subtraction angiography does not reliably prevent paraplegia associated with lumbar transforaminal epidural steroid injection. Pain Physician 15(6), 515–523 (2012).
  MedlineGoogle Scholar
• 120 Hodges SD, Castleberg RL, Miller T et al. Cervical epidural steroid injection with intrinsic spinal cord damage. Two case reports. Spine (Phila. Pa. 1976). 23(19), 2137–2142 (1998).
  Medline CASGoogle Scholar
• 121 Lee JH, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH. Spinal cord injury produced by direct damage during cervical transforaminal epidural injection. Reg. Anesth. Pain Med. 33(4), 377–379 (2008).
  MedlineGoogle Scholar
• 122 Benzon HT, Wong HY, Siddiqui T, Ondra S. Caution in performing epidural injections in patients on several antiplatelet drugs. Anesthesiology 91(5), 1558–1559 (1999).
  Medline CASGoogle Scholar
• 123 Abram SE, Hogan QH. Avoiding catastrophic complications from epidural steroid injections. APSF Newsletter 26(1), 8–9 (2011).
  Google Scholar
• 124 Stojanovic MP, Vu TN, Caneris O, Slezak J, Cohen SP, Sang CN. The role of fluoroscopy in cervical epidural steroid injections: an analysis of contrast dispersal patterns. Spine (Phila. Pa. 1976) 27(5), 509–514 (2002).
  MedlineGoogle Scholar
• 125 Goel A, Pollan JJ. Contrast flow characteristics in the cervical epidural space: an analysis of cervical epidurograms. Spine (Phila. Pa. 1976) 31(14), 1576–1579 (2006).
  MedlineGoogle Scholar
• 126 Rathmell JP, Benzon HT, Dreyfuss P et al. Safeguards to prevent neurologic complications after epidural steroid injections: recommendations from a multidisciplinary working group and national organizations. Anesthesiology doi:10.1097/ALN.0000000000000614 (2015) (Epub ahead of print).•• An expert multi-disciplinary working group and 13 stakeholder societies reviewed evidence and provided 17 recommendations for improving safety for transforaminal and interlaminar epidural injections.
  Google Scholar
• 127 Aldrete JA. Chronic adhesive arachnoiditis. Br. J. Anaesth. 93(2), 301–307 (2004).
  Medline CASGoogle Scholar
• 128 Lima RM, Navarro LH, Carness JM et al. Clinical and histological effects of the intrathecal administration of methylprednisolone in dogs. Pain Physician 13(5), 493–501 (2010).
  MedlineGoogle Scholar
• 129 Nanjayan SK, Swamy GN, Yallappa S, Bommireddy R. Arachnoiditis following caudal epidural injections for the lumbo-sacral radicular pain. Asian Spine J. 7(4), 355–358 (2013).
  MedlineGoogle Scholar
• 130 Na EH, Han SJ, Kim MH. Delayed occurrence of spinal arachnoiditis following a caudal block. J. Spinal Cord Med. 34(6), 616–619 (2011).
  MedlineGoogle Scholar
• 131 Young WF. Transient blindness after lumbar epidural steroid injection: a case report and literature review. Spine J. 27(21), E476–E477 (2002).
  Google Scholar
• 132 Kim W, Kim JS, Lim SC, Kim YI, Moon DE. Reversible posterior leukoencephalopathy syndrome after cervical transforaminal epidural steroid injection presenting as transient blindness. Anesth. Analg. 112(4), 967–970 (2011).
  MedlineGoogle Scholar
• 133 Browning DJ. Acute retinal necrosis following epidural steroid injections. Am. J. Ophthalmol. 136(1), 192–194 (2003).
  MedlineGoogle Scholar
• 134 Pizzimenti JJ, Daniel KP. Central serous chorioretinopathy after epidural steroid injection. Pharmacotherapy 25(8), 1141–1146 (2005).
  MedlineGoogle Scholar
• 135 Lee SB, Kim JY, Kim WJ, Cho CB, Iwase T, Jo YJ. Bilateral central serous chorioretinopathy with retinal pigment epithelium tears following epidural steroid injection. Indian J. Ophthalmol. 61(9), 514–515 (2013).
  MedlineGoogle Scholar
• 136 Hodges SD, Castleberg RL, Miller T et al. Cervical epidural steroid injection with intrinsic spinal cord damage. Two case reports. Spine 23(19), 2137–2142 (1998).
  Medline CASGoogle Scholar
• 137 Abram SE, Francis MC. Hazards of sedation for interventional pain procedures. APSF Newsletter 27(2), 29–31 (2012).
  Google Scholar
• 138 Shin J, Kim YC, Lee SC, Kim JH. A comparison of Quincke and Whitacre needles with respect to risk of intravascular uptake in S1 transforaminal epidural steroid injections: a randomized trial of 1376 cases. Anesth. Analg. 117(5), 1241–1247 (2013).
  Medline CASGoogle Scholar
• 139 Smuck M, Yu AJ, Tang CT, Zemper E. Influence of needle type on the incidence of intravascular injection during transforaminal epidural injections: a comparison of short-bevel and long-bevel needles. Spine J. 10(5), 367–371 (2010).
  MedlineGoogle Scholar
• 140 Nishio I. Cervical transforaminal epidural steroid injections: a proposal for optimizing the preprocedural evaluation with available imaging. Reg. Anesth. Pain Med. 39(6), 546–9 (2014).
  Medline CASGoogle Scholar
• 141 Fitzgerald RT, Bartynski WS, Collins HR. Vertebral artery position in the setting of cervical degenerative disease: implications for selective cervical transforaminal epidural injections. Interv. Neuroradiol. 19(4), 425–31 (2013).
  MedlineGoogle Scholar
• 142 Karasek M, Bogduk N. Temporary neurologic deficit after cervical transforaminal injection of local anesthetic. Pain Med. 5(2), 202–205 (2004).
  MedlineGoogle Scholar
• 143 Owlia MB, Salimzadeh A, Alishiri G, Haghighi A. Comparison of two doses of corticosteroid in epidural steroid injection for lumbar radicular pain. Singapore Med. J. 48(3), 241–245 (2007).
  Medline CASGoogle Scholar
• 144 Kang SS, Hwang BM, Son HJ et al. The dosages of corticosteroid in transforaminal epidural steroid injections for lumbar radicular pain due to a herniated disc. Pain Physician 14(4), 361–370 (2011).•• Triamcinolone 10 mg was found to be the minimum effective dose for transforaminal epidural steroid injection in this randomized clinical trial.
  MedlineGoogle Scholar
• 145 Whynes DK, McCahon RA, Ravenscroft A, Hardman J. Cost effectiveness of epidural steroid injections to manage chronic lower back pain. BMC Anesthesiol. 12, 26 (2012).
  MedlineGoogle Scholar
• 146 Bicket MC, Gupta A, Brown CH, Cohen SP. Epidural injections for spinal pain: a systematic review and meta-analysis evaluating the “control” injections in randomized controlled trials. Anesthesiology 119(4), 907–931 (2013).
  MedlineGoogle Scholar
• 147 Chang-Chien GC, Knezevic NN, McCormick Z, Chu SK, Trescot AM, Candido KD. Transforaminal versus interlaminar approaches to epidural steroid injections: a systematic review of comparative studies for lumbosacral radicular pain. Pain Physician 17(4), E509–E524 (2014).
  MedlineGoogle Scholar
• 148 Weingart SN, Callanan LD, Ship AN et al. A physician-based voluntary reporting system for adverse events and medical errors. J. Gen. Intern. Med. 16(12), 809–814 (2001).
  Medline CASGoogle Scholar
• 149 Peterfreund RA, Driscoll WD, Walsh JL et al. Evaluation of a mandatory quality assurance data capture in anesthesia: a secure electronic system to capture quality assurance information linked to an automated anesthesia record. Anesth. Analg. 112(5), 1218–1225 (2011).
  MedlineGoogle Scholar