Complications of fluoroscopically guided caudal epidural injections.

OBJECTIVES: To assess the incidence of complications of fluoroscopically guided caudal epidural injections. DESIGN: A retrospective cohort design study in which chart review was performed on patients, who presented with radiculopathy and received fluoroscopically guided caudal epidural steroid injections. All injections were performed consecutively over a 12-mo period. An independent observer reviewed medical charts, which included a 24-hr post procedure telephone call by an ambulatory surgery center nurse, who asked a standardized questionnaire about complications after the injections. Physician follow-up office notes 1 to 3 wk after injection along with epidurograms were reviewed. RESULTS: The charts of 139 patients, who received 257 injections, were reviewed. Complications per injection included 12 episodes of insomnia the night of the injection (4.7%), 9 transient nonpositional headaches that resolved within 24 hr (3.5%), 8 increased back pain (3.1%), 6 facial flushing (2.3%), 2 vasovagal reactions (0.8%), 2 episodes of nausea (0.8%), and 1 increased leg pain (0.4%). No dural punctures occurred. CONCLUSIONS: No major complications occurred. The incidence of minor complications was 15.6% per injection. All reactions resolved without morbidity and no patient required hospitalization.

Role of weight-bearing flexion and extension myelography in evaluating the intervertebral disc.

Magnetic resonance imaging has many advantages compared with myelography and/or computed tomography in evaluating the lumbar spine for herniated nucleus pulposus. The authors have included a series of three patients whose histories and physical examinations were clinically suggestive of herniated nucleus pulposus but whose magnetic resonance imaging scans were interpreted by a radiologist as a disc bulge without nerve root compression. Because all patients had not responded to a conservative care treatment program and surgical intervention was to be considered, subsequent testing with lumbar myelography with weight-bearing flexion and extension views demonstrated more clearly the presence of herniated nucleus pulposus along with compression of the nerve root; it also revealed that a positional change in the disc occurred with flexion and extension.

Complications of fluoroscopically guided transforaminal lumbar epidural injections.

OBJECTIVES: To assess the incidence of complications of fluoroscopically guided lumbar transforaminal epidural injections. DESIGN: A retrospective cohort design study. Patients presenting with radiculopathy, caused by either lumbar spinal stenosis or herniated nucleus pulposus confirmed by magnetic resonance imaging or computed tomography scanning, received transforaminal epidural steroid injections as part of a conservative care treatment plan. SETTING: A multidisciplinary spine care center. INTERVENTION: All injections were performed consecutively over a 4-month period by five physiatrists. An independent observer reviewed medical charts, which included a 24-hour postprocedure telephone call by an ambulatory surgery center nurse who had asked a standardized questionnaire about complications following the injections. Physician follow-up office notes 1 to 3 weeks after the injection, along with epiduragrams, were also reviewed. RESULTS: Two hundred seven patients who received 322 injections were reviewed. Complications per injection seen included 10 transient nonpositional headaches that resolved within 24 hours (3.1%), 8 increased back pain (2.4%), 2 increased leg pain (0.6%), 4 facial flushing (1.2%), 1 vasovagal reaction (0.3%), 1 increased blood sugar (258 mg/dL) in an insulin-dependent diabetic (0.3%), and 1 intraoperative hypertension (0.3%). No dural punctures occurred. CONCLUSIONS: There were no major complications. The incidence of minor complications was 9.6% per injection. All reactions resolved without morbidity, and no patient required hospitalization.