Vasovagal reactions and other complications of cervical vs. lumbar translaminar epidural steroid injections.
OBJECTIVE
To document the per patient rate of vasovagal reactions and other complications of cervical vs. lumbar translaminar epidural steroid injections.


BACKGROUND
Anecdotal observations at our institution suggested that vasovagal reactions are much more common during cervical epidural steroid injections than lumbar injections, and more frequent than previously reported.


METHODS
Records of 249 patients undergoing their first cervical epidural steroid injection were reviewed for vasovagal reactions and other adverse events. For comparison, a first lumbar epidural steroid injection performed by the same staff physician was matched to each cervical procedure and reviewed for complications.


RESULTS
The incidence of vasovagal reaction was 7 points more common (P < 0.001, 95% confidence interval 0.04-0.12) in the cervical group (8%) than in the lumbar group (1%). This correlates to an additional vasovagal reaction for every 14 patients who were treated with cervical injection in comparison with those treated with lumbar injection.


CONCLUSIONS
The risk of vasovagal reaction is significantly higher for cervical translaminar epidural steroid injections than for lumbar injections. The risk of vasovagal reaction remained higher for cervical injection even when adjusting for differences between the two populations. The higher rate of cervical vasovagal reactions may result from a combination of anxiety, the prone position with neck flexed, head drapes, and stimulus from a neck procedure.


CONCLUSIONS
Increased vigilance for patients undergoing translaminar cervical epidural steroid injections may be warranted. Clinicians may choose to consider these results when counseling patients regarding risk and the need for conscious sedation during the procedure.
Trentman
Terrence L
TL
Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, Arizona 85054, USA. trentman.terrence@mayo.edu
Rosenfeld
David M
DM
Seamans
David P
DP
Hentz
Joseph G
JG
Stanek
James P
JP
D000368:Aged; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D015994:Incidence; D007268:Injections, Epidural / Q000009:adverse effects* / Q000379:methods*; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D019462:Syncope, Vasovagal / Q000453:epidemiology / Q000209:etiology*