CT-guided transforaminal cervical and lumbar epidural injections

Area of Science:

• Pain Management
• Neurosurgery
• Radiology

Background:

• Transforaminal injections are a common procedure for pain management.
• Serious complications, including stroke and paraplegia, have been reported.
• Regulatory warnings highlight the risks associated with corticosteroid use in these injections.

Purpose of the Study:

• To emphasize the critical need for rigorous adherence to best practices in transforaminal injections.
• To review the indications, technical performance, and patient management protocols.
• To mitigate the risk of severe adverse events associated with the procedure.

Main Methods:

• Review of reported complications and regulatory warnings.
• Emphasis on precise needle placement in the posterior foramen.
• Validation of correct needle placement using contrast injection.
• Recommendation for specific corticosteroids like cortivazol (Altim®).

Main Results:

• Transforaminal injections demonstrate durable effectiveness in 60-70% of patients.
• Complications, though rare, can be severe, including neurological deficits.
• Meticulous technique and patient management are key to minimizing risks.

Conclusions:

• Rigor in indication, technique, and patient management is paramount for transforaminal injections.
• Proper needle positioning and contrast use are essential safety measures.
• While effective, the potential for serious complications necessitates a cautious approach.