Death after transforaminal cervical epidural steroid injection

Abstract

Epidural steroid injections (ESIs) are used to manage radicular pain in patients with spinal degenerative disk disease, spinal stenosis, and disk herniations. Although rare, devastating neurological complications and death have been reported after cervical transforaminal epidural steroid injections (CTESIs). Knowledge of the anatomy of the cervical spine, careful review of the available images, the use of the appropriate technique, disciplined and accurate imaging while performing the procedure, and continuous patient monitoring are mandatory while performing these injections. A low threshold for aborting the procedure should be considered if persistent venous runoff or vertebral artery outline is observed on plain fluoroscopy and digital subtraction angiography (DSA). Procedures should be aborted immediately if evidence of rapid vascular runoff ascending toward the vertebral artery or directed medially toward radicular arteries providing blood supply to the spinal cord is observed. CTESIs should always be performed by physicians who have had specific training, have proven experience with interventional pain management techniques, and are able to manage eventual complications.