Abbasi Arjang, Malhotra Gautam, Malanga Gerard, Elovic Elie P, Kahn Stuart
Long Island Spine Specialists, Commack, NY 11725, USA.
Spine (Phila Pa 1976). 2007 Sep 1;32(19):2144-51. doi: 10.1097/BRS.0b013e318145a360.
A comprehensive literature review.
To review and critically evaluate the past literature focusing on incidence and clinical presentation of complications associated with interlaminar cervical epidural steroid injection (ICESI). The overall goal is to guide the direction of future research and improve clinical care by increasing awareness of complications, their presentations, and management.
Although ICESI is considered a relatively safe procedure, a number of minor and major complications have been reported across the literature. Thus far, reports of complications are limited to retrospective studies, case reports, and data extrapolated from lumbar and thoracic procedures. As a result, the past literature has been of limited value with regard to facilitating both clinical care and future research efforts.
Medical databases were searched for studies of ICESI. The bibliographies of these papers were then searched as well. Papers focusing on cervical techniques that did not involve injection into the epidural space were discarded, as were studies of thoracic and lumbar spine injections. Reports of complications associated with ICESI were further subdivided into major and minor categories.
The reported rate of complications associated with ICESI varied between 0 and 16.8%.
There are significant limitations in the available literature discussing the complications associated with ICESI, but they strongly suggest that ICESI is a relatively safe procedure. Numerous potential adverse reactions have been associated with ICESI, with the vast majority being minor and transient in nature. However, serious complications may also result and may be technique related. Injectionists should be aware of the clinical presentations, rates, potential consequences, and appropriate techniques to avoid these complications. More studies are needed with specific focus on cervical complication rates, standardization of injection techniques, and differentiation between complications and poor efficacy. In addition, the use of a prospective randomized blinded controlled design would be beneficial.
全面的文献综述。
回顾并批判性地评估以往关于颈椎间孔硬膜外类固醇注射（ICESI）相关并发症的发生率和临床表现的文献。总体目标是通过提高对并发症、其表现及处理的认识，来指导未来的研究方向并改善临床护理。
尽管ICESI被认为是一种相对安全的操作，但文献中已报道了一些轻微和严重的并发症。迄今为止，并发症的报告仅限于回顾性研究、病例报告以及从腰椎和胸椎操作中推断的数据。因此，以往的文献在促进临床护理和未来研究方面价值有限。
在医学数据库中搜索ICESI的研究。随后也搜索了这些论文的参考文献。不涉及硬膜外间隙注射的颈椎技术相关论文以及胸椎和腰椎注射的研究均被排除。与ICESI相关的并发症报告进一步细分为主要和次要类别。
报道的与ICESI相关的并发症发生率在0%至16.8%之间。
在讨论与ICESI相关并发症的现有文献中存在重大局限性，但这些文献强烈表明ICESI是一种相对安全的操作。ICESI已被证实有许多潜在的不良反应，绝大多数为轻微且短暂性的。然而，也可能导致严重并发症，且可能与技术相关。注射人员应了解这些并发症的临床表现、发生率、潜在后果以及避免这些并发症的适当技术。需要更多专门关注颈椎并发症发生率、注射技术标准化以及并发症与疗效不佳区分的研究。此外，采用前瞻性随机双盲对照设计将是有益的。
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