Wozniak Gabriella H, Rana Anish A, Stephens Andrew R, El-Hassan Ramzi, Laplante Ben L, Patel Rajeev K
University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14623, United States of America.
Interv Pain Med. 2025 Jul 28;4(3):100622. doi: 10.1016/j.inpm.2025.100622. eCollection 2025 Sep.
BACKGROUND: Cervical transforaminal epidural steroid injections (CTFESI) are commonly used to treat cervical radicular pain, but concerns remain about their safety due to case reports of complications such as stroke, spinal cord injury and death. These complications have been associated with use of particulate steroids causing embolic infarcts from inadvertent intra-arterial injection. With the use of non-particulate steroids these complications have never been reported. Additionally, recent cohort studies have demonstrated safety. Yet many providers still consider these procedures to be unsafe. Additional work is needed to further elucidate the risk of complications after CTFESI. OBJECTIVE: The goal of this study is to demonstrate the safety of CTFESI in a large retrospective cohort study using non-particulate steroids. METHODS: Medical records of all consecutive patients who underwent CFTESI within a tertiary academic multidisciplinary spine center from December 2002 through September 2024 were retrospectively reviewed. Data collected included vertebral level of injection, major (stroke, seizure, spinal cord injury, and death) and minor (headache, diaphoresis, syncope) complications, ED/urgent care visits within 2 weeks of procedure, and length of follow up within the performing PM&R department. RESULTS: A total of 1018 CTFESI procedures involving 558 patients were reviewed. There were no major complications in our study and no patients necessitated an ED or urgent care visit. Of 1018 total procedures, 16 (1.57 %) were attempted and aborted mid-procedure. Of these, 3 procedures were aborted due to inability to access the neuroforamen, 6 procedures were aborted due to signs of vascular uptake and/or subjective symptoms of vascular uptake, 3 procedures were aborted due to patient inability to tolerate the procedure, and 4 procedures were aborted due to vasovagal response. Only 1 (0.01 %) procedure resulted in a vasovagal response (hypotension, bradycardia, dizziness) following completion of the procedure. CONCLUSION: This study demonstrated no major complications after fluoroscopy guided CTFESI with use of non-particulate steroids and standard safety techniques.
背景：颈椎经椎间孔硬膜外类固醇注射（CTFESI）常用于治疗颈椎神经根性疼痛，但由于有中风、脊髓损伤和死亡等并发症的病例报告，其安全性仍受到关注。这些并发症与使用颗粒状类固醇有关，因意外动脉内注射导致栓塞性梗死。使用非颗粒状类固醇从未报告过这些并发症。此外，最近的队列研究已证明其安全性。然而，许多医疗服务提供者仍认为这些操作不安全。需要进一步开展工作以阐明CTFESI后并发症的风险。 目的：本研究的目的是在一项使用非颗粒状类固醇的大型回顾性队列研究中证明CTFESI的安全性。 方法：回顾性分析2002年12月至2024年9月在一家三级学术多学科脊柱中心接受CTFESI的所有连续患者的病历。收集的数据包括注射的椎体节段、主要（中风、癫痫发作、脊髓损伤和死亡）和次要（头痛、出汗、晕厥）并发症、术后2周内的急诊/紧急护理就诊情况以及在康复医学科的随访时间。 结果：共回顾了涉及558例患者的1018例CTFESI操作。本研究中没有主要并发症，也没有患者需要急诊或紧急护理就诊。在总共1018例操作中，有16例（1.57%）在操作过程中尝试后中止。其中，3例因无法进入神经孔而中止，6例因血管摄取迹象和/或血管摄取的主观症状而中止，3例因患者无法耐受操作而中止，4例因血管迷走神经反应而中止。只有1例（0.01%）操作在完成后出现血管迷走神经反应（低血压、心动过缓、头晕）。 结论：本研究表明，在使用非颗粒状类固醇和标准安全技术进行荧光透视引导下的CTFESI后，没有主要并发症。
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