Epstein Nancy E, Agulnick Marc A
Professor of Clinical Neurosurgery, School of Medicine, State University of NY at Stony Brook and Editor-in-Chief Surgical Neurology International NY, USA, and c/o Dr. Marc Agulnick, 1122 Franklin Avenue Suite 106, Garden City, NY, USA.
Assistant Clinical Professor of Orthopedics, NYU Langone Hospital, Long Island, NY, USA, 1122 Franklin Avenue Suite 106, Garden City, NY, USA.
Surg Neurol Int. 2024 Sep 13;15:328. doi: 10.25259/SNI_701_2024. eCollection 2024.
Despite the lack of FDA (Food and Drug Administration) approval, cervical and lumbar epidural spinal injections are frequently performed in the US to address back pain and/or painful radiculopathy. The three major types of injections include; interlaminar/translaminar (ESI), transforaminal (TFESI), or caudal injections. Notably, most studies document little to no clear short-term, and no long-term benefits/efficacy for these injections vs. various placebos.
More adverse events (AE) occurred with cervical© rather than lumbar (L) injections, and more severe AE were attributed to C-TFESI vs. CESI injections.
Acute post injection AE symptoms were observed immediately or within 72 post-injection hours. These symptoms included; hypotension, acute respiratory distress, chest pain, upper extremity numbness, weakness, paresthesias, paralysis, and fevers. More AE were attributed to cervical C-TFESI vs. cervical CESI. These AE included; intramedullary/cord injections, intravascular injections (i.e. vertebral artery) resulting in brain stem/cerebellar/cord strokes, epidural abscess/infection, confusion, epidural hematomas, intracranial hypotension, and/or 6 nerve cranial palsies. AE for lumbar LESI/L-TFESI included; infections/abscess, epidural hematomas/subdural hematomas, intravascular injections, cerebrospinal fluid (CSF) leaks/dural tears (DT), and intracranial/postural hypotension. Notably, the vast majority of studies showed little to no short-term, and no long-term benefits for cervical or lumbar ESI/TFESI vs placebos (i.e. mostly consisting of normal saline alone, or saline plus local anesthesia).
Epidural cervical and lumbar ESI or TFESI spinal injections demonstrated minimal to no short-term, and no long-term benefits for the treatment of cervical and/or lumbar pain/radiculopathy vs. placebos. Further, more AE were observed for cervical vs. lumbar epidural injections overall, with more AE usually seen with TFESI vs. ESI procedures.
尽管美国食品药品监督管理局（FDA）未批准，但颈椎和腰椎硬膜外脊髓注射在美国仍经常用于治疗背痛和/或神经根性疼痛。三种主要的注射类型包括：椎板间/经椎板（ESI）、经椎间孔（TFESI）或骶管注射。值得注意的是，大多数研究表明，与各种安慰剂相比，这些注射在短期几乎没有明显效果，在长期也没有益处/疗效。
颈椎注射比腰椎注射出现更多不良事件（AE），且与颈椎硬膜外间隙注射（CESI）相比，颈椎经椎间孔硬膜外注射（C-TFESI）出现更严重的AE。
注射后急性AE症状在注射后立即或72小时内出现。这些症状包括：低血压、急性呼吸窘迫、胸痛、上肢麻木、无力、感觉异常、瘫痪和发热。与颈椎CESI相比，更多AE归因于颈椎C-TFESI。这些AE包括：髓内/脊髓内注射、血管内注射（即椎动脉）导致脑干/小脑/脊髓中风、硬膜外脓肿/感染、意识模糊、硬膜外血肿、颅内低压和/或第6对脑神经麻痹。腰椎ESI/L-TFESI的AE包括：感染/脓肿、硬膜外血肿/硬膜下血肿、血管内注射、脑脊液（CSF）漏/硬脑膜撕裂（DT）和颅内/体位性低血压。值得注意的是，绝大多数研究表明，与安慰剂（即大多仅由生理盐水或生理盐水加局部麻醉剂组成）相比，颈椎或腰椎ESI/TFESI在短期几乎没有明显效果，在长期也没有益处。
与安慰剂相比，颈椎和腰椎硬膜外ESI或TFESI脊髓注射在治疗颈椎和/或腰椎疼痛/神经根病方面短期益处极小或无，长期也无益处。此外，总体而言，颈椎硬膜外注射比腰椎硬膜外注射观察到更多AE，TFESI手术通常比ESI手术出现更多AE。
