Perspective: Risks/adverse events for epidural spinal injections.

Autor:	Epstein NE; Professor of Clinical Neurosurgery, School of Medicine, State University of NY at Stony Brook and Editor-in-Chief Surgical Neurology International NY, USA, and c/o Dr. Marc Agulnick, 1122 Franklin Avenue Suite 106, Garden City, NY, USA., Agulnick MA; Assistant Clinical Professor of Orthopedics, NYU Langone Hospital, Long Island, NY, USA, 1122 Franklin Avenue Suite 106, Garden City, NY, USA.
Jazyk:	angličtina
Zdroj:	Surgical neurology international [Surg Neurol Int] 2024 Sep 13; Vol. 15, pp. 328. Date of Electronic Publication: 2024 Sep 13 (Print Publication: 2024).
DOI:	10.25259/SNI_701_2024
Abstrakt:	Background: Despite the lack of FDA (Food and Drug Administration) approval, cervical and lumbar epidural spinal injections are frequently performed in the US to address back pain and/or painful radiculopathy. The three major types of injections include; interlaminar/translaminar (ESI), transforaminal (TFESI), or caudal injections. Notably, most studies document little to no clear short-term, and no long-term benefits/efficacy for these injections vs. various placebos. Methods: More adverse events (AE) occurred with cervical© rather than lumbar (L) injections, and more severe AE were attributed to C-TFESI vs. CESI injections. Results: Acute post injection AE symptoms were observed immediately or within 72 post-injection hours. These symptoms included; hypotension, acute respiratory distress, chest pain, upper extremity numbness, weakness, paresthesias, paralysis, and fevers. More AE were attributed to cervical C-TFESI vs. cervical CESI. These AE included; intramedullary/cord injections, intravascular injections (i.e. vertebral artery) resulting in brain stem/cerebellar/cord strokes, epidural abscess/infection, confusion, epidural hematomas, intracranial hypotension, and/or 6 th nerve cranial palsies. AE for lumbar LESI/L-TFESI included; infections/abscess, epidural hematomas/subdural hematomas, intravascular injections, cerebrospinal fluid (CSF) leaks/dural tears (DT), and intracranial/postural hypotension. Notably, the vast majority of studies showed little to no short-term, and no long-term benefits for cervical or lumbar ESI/TFESI vs placebos (i.e. mostly consisting of normal saline alone, or saline plus local anesthesia). Conclusion: Epidural cervical and lumbar ESI or TFESI spinal injections demonstrated minimal to no short-term, and no long-term benefits for the treatment of cervical and/or lumbar pain/radiculopathy vs. placebos. Further, more AE were observed for cervical vs. lumbar epidural injections overall, with more AE usually seen with TFESI vs. ESI procedures. Competing Interests: There are no conflicts of interest. (Copyright: © 2024 Surgical Neurology International.)
Databáze:	MEDLINE
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