Neurological complications associated with epidural steroid injections

Current Pain and Headache Reports
Laxmaiah Manchikanti, Joshua A Hirsch

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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Citations

Jun 11, 2015·Pain Management·Laxmaiah Manchikanti, Ramsin M Benyamin
May 26, 2016·Expert Review of Neurotherapeutics·Laxmaiah ManchikantiJoshua A Hirsch
Aug 3, 2016·The Spine Journal : Official Journal of the North American Spine Society·Laxmaiah Manchikanti, Joshua A Hirsch
Sep 14, 2017·Journal of Neurointerventional Surgery·Dimitrios K FilippiadisAlexis Kelekis
Jul 16, 2015·The Korean Journal of Pain·Laxmaiah Manchikanti, Joshua A Hirsch
Mar 30, 2019·Anesthesia and Analgesia·Christopher R AbrechtRichard D Urman
Sep 21, 2017·Operative Neurosurgery·Gabriel A SmithJonathan P Miller
Mar 30, 2017·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Adam Meir, Keith Bush
Oct 11, 2017·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Jeremy I SimonZachary Broyer

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