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Related Experiment Video

Updated: May 29, 2026

Ultrasound-Guided Needle Release Combined with Corticosteroid Injection for the Treatment of Supinator Syndrome
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Injectable corticosteroid preparations: an embolic risk assessment by static and dynamic microscopic analysis.

P J MacMahon1, M J Shelly, D Scholz

  • 1Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland. petermacmahon@yahoo.com

AJNR. American Journal of Neuroradiology
|September 24, 2011
PubMed
Summary

Transforaminal corticosteroid injections with methylprednisolone acetate (MPA) and triamcinolone acetonide (TA) pose an infarction risk due to embolization. Dexamethasone sodium phosphate (DSP) is safe for cervical transforaminal epidural steroid injections (TFESI).

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Area of Science:

  • Neurology
  • Pharmacology
  • Interventional Radiology

Background:

  • Transforaminal corticosteroid (CS) injections are linked to severe central nervous system (CNS) adverse events, including infarction.
  • The embolic potential of CS preparations during transforaminal injection is a significant concern.

Purpose of the Study:

  • To microscopically analyze static and dynamic appearances of CS preparations.
  • To evaluate the embolic potential of CSs in transforaminal injections, focusing on CNS adverse events.

Main Methods:

  • Examined pharmaceutical preparations of methylprednisolone acetate (MPA), triamcinolone acetonide (TA), and dexamethasone sodium phosphate (DSP).
  • Utilized dynamic imaging to simulate crystal flow in spinal cord arterioles.
  • Assessed crystal aggregation and size changes after mixing with plasma.

Main Results:

  • MPA and TA contain crystals (MPA: 0.4-26 μm; TA: 0.5-110 μm), while DSP is essentially free of significant crystals.
  • CS crystals maintained integrity and aggregation potential, acting as emboli in dynamic imaging.
  • Mixing with plasma reduced aggregate size but not integrity.

Conclusions:

  • Inadvertent intra-arterial injection of MPA and TA during TFESI carries a substantial risk of infarction due to embolization.
  • Dexamethasone sodium phosphate (DSP) is fully soluble and poses no embolic risk to arterioles.
  • Avoid insoluble CSs like MPA and TA during cervical TFESI to prevent adverse CNS events.