Complications of interlaminar cervical epidural steroid injections: a review of the literature.
METHODS
A comprehensive literature review.


OBJECTIVE
To review and critically evaluate the past literature focusing on incidence and clinical presentation of complications associated with interlaminar cervical epidural steroid injection (ICESI). The overall goal is to guide the direction of future research and improve clinical care by increasing awareness of complications, their presentations, and management.


BACKGROUND
Although ICESI is considered a relatively safe procedure, a number of minor and major complications have been reported across the literature. Thus far, reports of complications are limited to retrospective studies, case reports, and data extrapolated from lumbar and thoracic procedures. As a result, the past literature has been of limited value with regard to facilitating both clinical care and future research efforts.


METHODS
Medical databases were searched for studies of ICESI. The bibliographies of these papers were then searched as well. Papers focusing on cervical techniques that did not involve injection into the epidural space were discarded, as were studies of thoracic and lumbar spine injections. Reports of complications associated with ICESI were further subdivided into major and minor categories.


RESULTS
The reported rate of complications associated with ICESI varied between 0 and 16.8%.


CONCLUSIONS
There are significant limitations in the available literature discussing the complications associated with ICESI, but they strongly suggest that ICESI is a relatively safe procedure. Numerous potential adverse reactions have been associated with ICESI, with the vast majority being minor and transient in nature. However, serious complications may also result and may be technique related. Injectionists should be aware of the clinical presentations, rates, potential consequences, and appropriate techniques to avoid these complications. More studies are needed with specific focus on cervical complication rates, standardization of injection techniques, and differentiation between complications and poor efficacy. In addition, the use of a prospective randomized blinded controlled design would be beneficial.
Abbasi
Arjang
A
Long Island Spine Specialists, Commack, NY 11725, USA. abbasiar@yahoo.com
Malhotra
Gautam
G
Malanga
Gerard
G
Elovic
Elie P
EP
Kahn
Stuart
S
D000698:Analgesia / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002574:Cervical Vertebrae; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D011843:Radiculopathy / Q000188:drug therapy*; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000209:etiology*; D013256:Steroids / Q000008:administration & dosage*; D013577:Syndrome; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D013256:Steroids