Complications in image-guided musculoskeletal injections

Area of Science:

• Musculoskeletal radiology
• Interventional pain management
• Medical imaging procedures

Background:

• Image-guided musculoskeletal injections are frequently performed for diagnosis and treatment.
• Understanding the complication profile is crucial for patient safety and procedural optimization.
• Previous data on complication rates may vary, necessitating site-specific analysis.

Purpose of the Study:

• To determine the incidence and characteristics of complications following image-guided musculoskeletal injections.
• To identify specific injection types or anatomical locations associated with higher complication risks.
• To evaluate the overall safety of image-guided musculoskeletal interventions.

Main Methods:

• Retrospective review of departmental records for patients undergoing image-guided musculoskeletal injections between March 2016 and January 2020.
• Identification and classification of all reported complications as minor or major.
• Statistical comparison of complication rates across different injection categories (cervical spine, lumbar facet, lumbar nerve root, caudal epidural, 'other') using Fisher's exact test.

Main Results:

• A total of 8226 patients underwent procedures, with 100 (1.2%) reporting complications.
• One major complication (requiring surgery) and 99 minor complications were recorded.
• Injections categorized as 'other' had a significantly higher complication rate (1.86%). Specifically, glenohumeral (2.97%) and sacroiliac (3.51%) joint injections showed increased risk.
• No significant difference in complication rates was observed for cervical spine, lumbar facet, lumbar nerve root, or caudal epidural injections, nor between fluoroscopic and ultrasound guidance.

Conclusions:

• Image-guided musculoskeletal injections demonstrate a high safety profile with a low overall complication incidence of 1.2%.
• The vast majority (99%) of complications are minor and do not require significant intervention.
• While generally safe, specific procedures like glenohumeral and sacroiliac joint injections warrant careful consideration due to a higher associated risk.