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Neurological Complications Associated with Epidural Steroid Injections

  • Anesthetic Techniques in Pain Management (D Wang, Section Editor)
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Abstract

Multiple case reports of neurological complications resulting from intraarterial injection of corticosteroids have led the Food and Drug Administration (FDA) to issue a warning, requiring label changes, warning of serious neurological events, some resulting in death. The FDA has identified 131 cases of neurological adverse events, including 41 cases of arachnoiditis. A review of the literature reveals an overwhelming proportion of the complications are related to transforaminal epidural injections, of which cervical transforaminal epidural injections constituted the majority of neurological complications. Utilization data of epidural injections in the Medicare population revealed that cervical transforaminal epidural injections constitute only 2.4 % of total epidural injections and <5 % of all transforaminal epidural injections. Multiple theories have been proposed as the cause of neurological injury including particulate steroid, arterial intimal flaps, arterial dissection, dislodgement of plaque causing embolism, arterial muscle spasm, and embolism of a fresh thrombus following disruption of the intima.

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Dr. Laxmaiah Manchikanti and Dr. Joshua A. Hirsch each declare no potential conflicts of interest.

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Authors and Affiliations

  1. Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, KY, 42003, USA

    Laxmaiah Manchikanti

  2. Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA

    Laxmaiah Manchikanti

  3. Massachusetts General Hospital, 55 Blossom St., Gray 289, Boston, MA, 02114, USA

    Joshua A. Hirsch

  4. Harvard Medical School, Boston, MA, USA

    Joshua A. Hirsch

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  1. Laxmaiah Manchikanti
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  2. Joshua A. Hirsch
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Correspondence to Laxmaiah Manchikanti.

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

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Manchikanti, L., Hirsch, J.A. Neurological Complications Associated with Epidural Steroid Injections. Curr Pain Headache Rep 19, 10 (2015). https://doi.org/10.1007/s11916-015-0482-3

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