ABSTRACT
INTRODUCTION: Cervical radiculopathy is a common condition affecting many people each year. The efficacy of cervical epidural steroid injection for patients that have not responded to conservative treatment has been demonstrated. Even with confirmatory radiocontrast dispersion indicating correct presence in the epidural space, there still may be rostral spread of steroid and local anesthetic resulting in an unusual presentation of symptoms and potentially life threatening complications. CASE PRESENTATION: We present the case of a 52-year-old male presenting for a right sided C6-C7 epidural steroid injection. The epidural space was identified and a Tuohy needle was advanced using loss of resistance technique. Isovue contrast was used for needle localization and after confirmation of the presence of the contrast in the epidural space, dexamethasone and lidocaine were injected to the area without any complications. Five minutes after arrival to the PACU, the patient developed a constellation of symptoms including inability to swallow, vertigo, and horizontal nystagmus which required reassurance and vigilant monitoring. CONCLUSIONS: Interventional pain physicians must be cognizant that even with confirmatory epidural radiocontrast dispersion, there still may be inadvertent uptake of steroid and local anesthetic rostrally resulting in an unusual presentation of symptoms and potentially life threatening complications. Potential reasons for the rostral spread include inadvertent subdural or intrathecal injection.
ABSTRACT
OBJECTIVES: To assess the prevalence of adverse effects or complications from fluoroscopically guided thoracic interlaminar epidural steroid injections. DESIGN: A retrospective study with independent observer review. Patients presenting with thoracic radicular pain, caused by either herniated nucleus pulposus or thoracic spondylosis as confirmed by magnetic resonance imaging, received an interlaminar thoracic epidural steroid injection as part of a conservative-care treatment plan. The study was performed in a multidisciplinary spine care center. All injections were performed over a 5-yr period. An independent observer reviewed medical charts, which included a 24-hr postprocedure standardized questionnaire completed by telephone by an ambulatory surgical center nurse. Ambulatory surgical center operative reports and physician follow up office notes up to 3 mos after the procedures, along with epidurograms, were also reviewed. RESULTS: A total of 21 patients who received 39 injections were reviewed. Adverse effects or complications per injection observed included three with increased pain at injection site (7.7%), two with facial flushing (5.1%), one transient nonpositional headache (2.6%), one episode of insomnia the night of the injection (2.6%), and one episode of fever the night of the procedure (2.6%). Statistical analysis revealed no significant difference based on diagnosis (herniated nucleus pulposus vs. spondylosis, P = 0.9156), and age was not linked to higher prevalence of adverse/effects complications (P = 0.3137). CONCLUSIONS: No major complication arose. Adverse effects did occur with a rate of 20.5%. All adverse effects resolved without morbidity. No statistical difference was observed in the rate of adverse effects in patients with herniated nucleus pulposus or spondylosis.
Subject(s)
Fluoroscopy/statistics & numerical data , Intervertebral Disc Displacement/drug therapy , Spinal Osteophytosis/drug therapy , Steroids/administration & dosage , Steroids/adverse effects , Thoracic Vertebrae , Age Distribution , Aged , Aged, 80 and over , Cohort Studies , Female , Fever/etiology , Flushing/etiology , Headache/etiology , Humans , Injections, Epidural/adverse effects , Injections, Epidural/methods , Liability, Legal , Male , Middle Aged , Neck Pain/etiology , Occupational Diseases/drug therapy , Outcome and Process Assessment, Health Care , Retrospective Studies , Sleep Initiation and Maintenance Disorders/etiologyABSTRACT
BACKGROUND: Epidural steroid injections (ESI) are commonly used in managing radicular pain. The risk of complications with epidural steroids is small, with the majority of complications being non-specific. Flushing is a known side effect of corticosteroid administration. The occurrence of flushing after epidural steroids has not been studied prospectively. OBJECTIVE: To compare flushing as a side effect of Betamethasone acetate/Betamethasone sodium phosphate (Celestone) vs. Methylprednisolone (DepoMedrol) in fluoroscopically guided epidural steroid injections. STUDY DESIGN: Non-concurrent Prospective Database Study METHODS: Two-hundred forty patients, who underwent epidural steroid injections in the University of Rochester Spine Center in the year 2001 were included. Eighty-one patients underwent epidural steroid injections with Celestone. One hundred fifty nine patients received treatment with Depo-Medrol. Patients were contacted two days after the procedure by a staff member and specifically asked about the presence of flushing following steroid injection. The answers were recorded as "yes" or "no". RESULTS: Out of 81 patients who underwent ESI with Betamethasone acetate/Betamethasone sodium phosphate, 13 reported a flushing reaction (16%). Out of 159 patients, who underwent ESI with Methylprednisolone, 14 reported a flushing reaction (9%). This side effect difference was not statistically significant (p < 0.143 and odds ratio of 0.505). The overall incidence of flushing was approximately 11%. CONCLUSION: Flushing reaction appears to be more widespread than previously assumed, with an overall incidence of 11%. There was no significant difference in self-reported flushing reactions following lumbar epidural steroid injections using either betamethasone or methylprednisolone.
