Is Cervical Epidural Steroid Injection Safe and Efficacious for the Treatment of Cervical Radiculopathy?

Introduction: Transforaminal epidural steroid injection (TFESI) is a widely used nonsurgical procedure in the treatment of patients with radiculopathy. It is efficacious in relieving pain, but a number of complications are being reported. Recently, increasing frequency of major complications, such as spinal cord infarction and cerebral infarction, has been reported with the use of a particulate steroid within fluoroscopic-guided procedures. Methods: We report a 49-year-old man with a history of chronic cervical radiculopathy, who experienced a devastating complication after TFESI. Results: After 2 min of regular TFESI, the patient abruptly experienced muscle weakness in both upper extremities and within 5 min the patient became quadriplegic. Despite active rehabilitation, the patient remained bed-ridden 4 years after the catastrophic event. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI in Korea. Conclusion: Considering the risk of dreadful complications, which appear in an unpredictable manner, TFESI with fluoroscopic guidance should be done only with a nonparticulate steroid.

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Cervical Interlaminar Epidural Steroid Injection for Unilateral Cervical Radiculopathy: Comparison of Midline and Paramedian Approaches for Efficacy

Korean Journal of Radiology ◽

10.3348/kjr.2015.16.3.604 ◽

2015 ◽

Vol 16 (3) ◽

pp. 604 ◽

Cited By ~ 6

Author(s):

Ji Young Yoon ◽

Jong Won Kwon ◽

Young Cheol Yoon ◽

Jongseok Lee

Keyword(s):

Steroid Injection ◽

Cervical Radiculopathy ◽

Epidural Steroid Injection ◽

Interlaminar Epidural Steroid Injection ◽

Epidural Steroid

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Directional Preference Following Epidural Steroid Injection in Three Patients with Acute Cervical Radiculopathy

Pain Practice ◽

10.1111/papr.12000 ◽

2012 ◽

Vol 13 (7) ◽

pp. 559-565 ◽

Cited By ~ 4

Author(s):

Mehul J. Desai ◽

Girish Padmanabhan ◽

Ajai Simbasivan ◽

Gladys G. Kamanga-Sollo ◽

Ajay Dharmappa

Keyword(s):

Steroid Injection ◽

Cervical Radiculopathy ◽

Epidural Steroid Injection ◽

Directional Preference ◽

Epidural Steroid

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MRI Prediction of Therapeutic Response to Epidural Steroid Injection in Patients with Cervical Radiculopathy

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/phm.0b013e3181951890 ◽

2009 ◽

Vol 88 (3) ◽

pp. 239-246 ◽

Cited By ~ 13

Author(s):

David E. Fish ◽

Hisashi W. Kobayashi ◽

Tony L. Chang ◽

Quynh Pham

Keyword(s):

Therapeutic Response ◽

Steroid Injection ◽

Cervical Radiculopathy ◽

Epidural Steroid Injection ◽

Epidural Steroid

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Patient-Reported Outcomes and Satisfaction after Cervical Epidural Steroid Injection for Cervical Radiculopathy

10.31661/gmj.v8i0.1478 ◽

2019 ◽

Vol 8 ◽

Author(s):

Masoud Hashemi ◽

Payman Dadkhah ◽

Mehrdad Taheri ◽

Mahshid Ghasemi ◽

Ali Hosseinpoor ◽

...

Keyword(s):

Patient Satisfaction ◽

Pain Relief ◽

Patient Reported Outcomes ◽

Steroid Injection ◽

Cervical Radiculopathy ◽

Epidural Steroid Injection ◽

Patient Reported ◽

The Mean ◽

Epidural Steroid

Background: Cervical radiculopathy caused by disc herniation is a frequent public health issue with economical and socio-professional impacts. The objective of the present study is to evaluate the patient-reported outcomes and satisfaction from cervical epidural steroid injection during a 2-year follow-up. Materials and Methods: Results based on patients’ reports from a previously performed intervention of cervical epidural steroid injection on patients with cervical radiculopathy due to cervical disc herniation are prospectively collected. Outcome measures are Neck Disability Index (NDI), numerical rating scale (NRS) for pain assessment, and 5-scale patient satisfaction questionnaire (PSQ) plus opioid medication for pain relief, additional injections, and progression to surgery. Results: Of total 37 cases, 34 were available for follow-up after 2-year postoperatively. The mean preoperative NDI was 21.17 and improved to 17.38, and the mean NRS was 7.7 and improved to 5.00; both were statistically significant. Mean patient satisfaction after 2 years was 3.17 out of 5. 11 cases needed additional injections, and 4 of patients proceeded to surgery. Conclusion: We showed that transforaminal cervical epidural steroid injection for cervical radiculopathy is an effective non-surgical treatment option, providing significant pain relief and functional improvement during 2-years follow-up along with higher-than-average patient satisfaction in most of our patients. [GMJ.2019;8:e1478]

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Hemorrhagic Infarction of Cerebellum and Brainstem Due to Cervical Epidural Steroid Injection – Case Report and Review of the Literature

Academic Forensic Pathology ◽

10.1177/1925362118821494 ◽

2018 ◽

Vol 8 (4) ◽

pp. 952-956

Author(s):

Connie Bao ◽

Shiping Bao

Keyword(s):

Steroid Injection ◽

Adverse Event Reporting System ◽

Cervical Radiculopathy ◽

Adverse Event Reporting ◽

Review Literature ◽

Epidural Steroid Injection ◽

Serious Adverse Events ◽

Painful Condition ◽

Epidural Steroid Injections ◽

Epidural Steroid

Radiculopathy is a painful condition usually due to a compressed nerve in the spine. It is reported that cervical radiculopathy has an annual incidence of 83.2 cases per 100 000 people. Cervical epidural steroid injection is one of the main treatments, but it can result in serious adverse events, including loss of vision, stroke, paralysis, and death. A 69-year-old female died after receiving the second of three planned C5/C6 epidural steroid injections. The autopsy revealed extensive hemorrhage and necrosis of the entire right side of the cerebellum and nearby brainstem, and extensive petechial hemorrhage of the left side of the cerebellum. This report discusses the importance of a complete autopsy in the case of death due to cervical epidural steroid injection and reporting the case either to peer review literature or to the Food and Drug Administration Adverse Event Reporting System (F AERS) database.

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