Incidence and characteristics of complications from epidural steroid injections

Epidural steroid injections are frequently used in the management of spinal pain, but reports on the incidence of complications from this procedure vary. This study seeks to determine the incidence of complications resulting from this procedure, and to compare the rate of complications in transforaminal vs interlaminar injections.

The design of the study was a retrospective chart review of epidural steroid injections in our academic physiatry practice over a 7-year period. A query of our electronic medical record identified all injection patients who contacted their physician or had a clinic visit or emergency department visit within 10 days of the procedure. Charts were individually reviewed for both major complications and minor complaints.

A total of 4265 injections were performed on 1,857 patients over 7 years; 161 cervical interlaminar injections, 123 lumbar interlaminar injections, 17 caudal injections, and 3,964 lumbar transforaminal injections. No major complications were identified. There were 103 minor complications, for an overall complication per injection rate of 2.4%. The most common complications were increased pain (1.1%), pain at injection site (0.33%), persistent numbness (0.14%), and "other" (0.80%). Complications were less common in transforaminal injections (2.1%), than in interlaminar injections (6.0%). One patient experienced a self-limited headache resulting from dural puncture during an interlaminar injection.

Fluoroscopically guided epidural steroid injections are a safe and well-tolerated intervention for cervical or lumbar pain and radiculopathy. Minor complications are uncommon, and most involve increases in pain. Transforaminal injections may result in fewer minor complications than interlaminar injections.