Key safety considerations when administering epidural steroid injections.

Area of Science:

• Neurology
• Pain Management
• Public Health

Background:

• Epidural steroid injections (ESIs) are common pain management procedures.
• Recent years have seen increased discussion regarding serious neurological complications associated with ESIs.
• The US Food and Drug Administration (FDA) issued a warning due to severe neurological events, including fatalities.

Purpose of the Study:

• To describe the prevalence of epidural injection administration.
• To review identified complications, including neurological adverse events and fungal meningitis.
• To discuss the pathoanatomy, mechanisms of injury, and preventive strategies for these complications.

Main Methods:

• Review of literature on epidural injection complications.
• Analysis of FDA-identified adverse events, including neurological events and fungal meningitis cases.
• Focus on complications related to transforaminal epidural injections, particularly in the cervical region.

Main Results:

• The FDA identified 131 neurological adverse events, 41 cases of arachnoiditis, and 700 cases of fungal meningitis linked to contaminated steroids.
• A significant proportion of complications are associated with transforaminal epidural injections.
• Cervical transforaminal epidural injections represent the majority of these specific complications.

Conclusions:

• Transforaminal epidural injections, especially cervical ones, are linked to a high proportion of serious complications.
• Preventive strategies are crucial to mitigate risks associated with epidural steroid injections.
• Understanding pathoanatomy and mechanisms of injury is key to improving patient safety.