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Complications Associated with Lumbar Transforaminal Epidural Steroid Injections


Purpose of Review

Low back pain with radicular symptoms is a common cause of disability in the adult population in the USA. Lumbar transforaminal epidural steroid injection (TFESI) is one of the most frequently used intervention for lumbar radiculitis. The purpose of this review is to evaluate complications associated with lumbar TFESI.

Recent Findings

Based on the literature review, the reported rate of minor complications was between 2.4 and 9.6%. The major complications including spinal abscess, spinal cord infarct, and epidural hematoma were documented as case reports. Some patients with spinal cord infarct had permanent neurologic deficits, while the other patients had recovery of neurological function after surgical or medical intervention.


This review identifies both the minor and major complications related to lumbar transforaminal epidural steroid injections. According to this review, most complications are minor. Lumbar TFESI can be considered a safe treatment in the management of lumbar radicular pain. However, pain specialists should be aware of the potentially devastating major complications. Early recognition and treatment of complications are crucial for improving the outcome.

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  1. Balague F, Mannion AF, Pellise F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482–91.

    Article  PubMed  Google Scholar 

  2. Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin. 2007;25(2):387–405.

    Article  PubMed  Google Scholar 

  3. Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Freeman TL, Slaten WK. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil. 2000;81(8):1045–50.

    Article  CAS  PubMed  Google Scholar 

  4. Ackerman WE 3rd, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg. 2007;104(5):1217–22 tables of contents.

    Article  PubMed  Google Scholar 

  5. Roberts ST, Willick SE, Rho ME, Rittenberg JD. Efficacy of lumbosacral transforaminal epidural steroid injections: a systematic review. PM R. 2009;1(7):657–68.

    Article  PubMed  Google Scholar 

  6. Manchikanti L, Pampati V, Hirsch JA. Utilization of interventional techniques in managing chronic pain in Medicare population from 2000 to 2014: an analysis of patterns of utilization. Pain Physician. 2016;19(4):E531–46.

    PubMed  Google Scholar 

  7. Manchikanti L, Malla Y, Wargo BW, Cash KA, Pampati V, Fellows B. A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections. Pain Physician. 2012;15(2):131–40.

    PubMed  Google Scholar 

  8. McGrath JM, Schaefer MP, Malkamaki DM. Incidence and characteristics of complications from epidural steroid injections. Pain Med. 2011;12(5):726–31.

    Article  PubMed  Google Scholar 

  9. Karaman H, Kavak GO, Tufek A, Yldrm ZB. The complications of transforaminal lumbar epidural steroid injections. Spine (Phila Pa 1976). 2011;36(13):E819–24.

    Article  Google Scholar 

  10. Lyders EM, Morris PP. A case of spinal cord infarction following lumbar transforaminal epidural steroid injection: MR imaging and angiographic findings. AJNR Am J Neuroradiol. 2009;30(9):1691–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kabbara A, Rosenberg SK, Untal C. Methicillin-resistant Staphylococcus aureus epidural abscess after transforaminal epidural steroid injection. Pain Physician. 2004;7(2):269–72.

    PubMed  Google Scholar 

  12. Houten JK, Errico TJ. Paraplegia after lumbosacral nerve root block: report of three cases. Spine J. 2002;2(1):70–5.

    Article  PubMed  Google Scholar 

  13. Huntoon MA, Martin DP. Paralysis after transforaminal epidural injection and previous spinal surgery. Reg Anesth Pain Med. 2004;29(5):494–5.

    Article  PubMed  Google Scholar 

  14. Kennedy DJ, Dreyfuss P, Aprill CN, Bogduk N. Paraplegia following image-guided transforaminal lumbar spine epidural steroid injection: two case reports. Pain Med. 2009;10(8):1389–94.

    Article  PubMed  Google Scholar 

  15. Kim SI, Lee DH, Kim SH, Cho YH. Spinal epidural hematoma occurring at a distance from the transforaminal epidural injection site: a case report. Medicine (Baltimore). 2019;98(30):e16654.

    Article  Google Scholar 

  16. Gungor S, Aiyer R. Epidural hematoma development contralateral to dura after lumbar transforaminal epidural steroid injection. Pain Manag. 2017;7(5):367–75.

    Article  PubMed  Google Scholar 

  17. Desai MJ, Dua S. Perineural hematoma following lumbar transforaminal steroid injection causing acute-on-chronic lumbar radiculopathy: a case report. Pain Pract. 2014;14(3):271–7.

    Article  PubMed  Google Scholar 

  18. Goodman BS, Bayazitoglu M, Mallempati S, Noble BR, Geffen JF. Dural puncture and subdural injection: a complication of lumbar transforaminal epidural injections. Pain Physician. 2007;10(5):697–705.

    PubMed  Google Scholar 

  19. Cicala RS, Thoni K, Angel JJ. Long-term results of cervical epidural steroid injections. Clin J Pain. 1989;5(2):143–5.

    Article  CAS  PubMed  Google Scholar 

  20. Horlocker TT, Wedel DJ, Benzon H, Brown DL, Enneking FK, Heit JA, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA consensus conference on neuraxial anesthesia and anticoagulation). Reg Anesth Pain Med. 2003;28(3):172–97.

    PubMed  Google Scholar 

  21. Furman MB, Giovanniello MT, O'Brien EM. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine (Phila Pa 1976). 2003;28(1):21–5.

    Article  Google Scholar 

  22. Bogduk N, Dreyfuss P, Baker R, et al. Complications of spinal diagnostic and treatment procedures. Pain Med. 2008;6:S11–34.

    Article  Google Scholar 

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Correspondence to Andrew T. Ng.

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Andrew Ng and Andrew Chang declare no conflict of interest.

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This article is part of the Topical Collection on Anesthetic Techniques in Pain Management

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Chang, A., Ng, A.T. Complications Associated with Lumbar Transforaminal Epidural Steroid Injections. Curr Pain Headache Rep 24, 67 (2020).

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