Comparable Overall Risk of Neurological Adverse Events Following Cervicothoracic Interlaminar and Transforaminal...

A retrospective cohort study.

To characterize the incidence and odds of neurological adverse events following interlaminar (IL) and transforaminal (TF) cervicothoracic epidural spinal injections (CESI).

CESI may be considered in the management of various cervical pathology. Adverse events, although rare, can be devastating and have been reported following both IL and TF injections. The literature is mixed with regard to the risk profile of these two types of CESI, but is largely limited to case reports, single-centered studies, and literature reviews, which may incompletely characterize the relative risk of these injections at a national level.

All adult patients undergoing IL and TF-CESI were identified from a large, national, multi-insurance database. The incidence of any postinjection neurological complication was reported per 1000 patients. The odds of specific neurological adverse events occurring within 48 hours following TF-CESI, relative to IL-CESI, were compared by multivariable logistic regression controlling for age, sex, and Elixhauser comorbidity index (ECI).

A total of 1,073,215 IL-CESI patients and 220,597 TF-CESI patients were identified. The overall incidence of any neurological complication following IL and TF-CESI occurred at a rate of 4.15 and 4.56 per 1000 patients, respectively ( P =0.889). TF-CESI was associated with higher odds ratio (OR) of nerve root injury (OR: 1.69, P <0.001), but lower odds of epidural hematoma (OR: 0.60, P =0.040), relative to IL-CESI. Conversely, no other neurological adverse events were statistically different between approaches ( P >0.05 for all).

Following IL and TF-CESI, adverse events are relatively rare but not absent. Although the odds of the majority of individual neurological adverse events were found to be similar, both approaches were independently associated with specific complications. Providers should, therefore, recognize that, at the national level, one CESI approach may not be universally associated with a lower risk of complications.