title: Adverse events associated with fluoroscopically guided lumbosacral transforaminal epidural steroid injections.
abstract: BACKGROUND
  Although the types and incidence of adverse events (AEs) associated with transforaminal epidural steroid injection (TFESI) have been described, no study has used a systematic standardized questionnaire to solicit AEs from patients to capture an accurate range and incidence of complications.
  
  
  OBJECTIVE
  The aim was to systematically identify the types and incidence of AEs associated with TFESI. Additionally, this study evaluated demographic and clinical factors that may predict a higher risk of an AE.
  
  
  METHODS
  This was a retrospective cohort study from a multiphysician academic PM&R clinic.
  
  
  METHODS
  Patients, aged 19 to 89, who underwent a fluoroscopically guided TFESI for lumbosacral radicular pain between 2004 and 2007 were included.
  
  
  METHODS
  The relationship of AEs with gender, age, trainee presence, steroid type, preprocedure visual analog scale (VAS) pain score, systolic blood pressure, fluoroscopy time, and corticosteroid injectate volume was analyzed.
  
  
  METHODS
  Adverse event data were collected using a survey both immediately and at 24 to 72 hours after TFESI. Statistical analysis was performed using the chi-square, Fisher exact, or Wilcoxon rank sum two-sided tests. Logistic regression analysis was also performed. C.P. is the owner of Rehabilitation Institute of Chicago Physiatric Log & Analysis System computer software.
  
  
  RESULTS
  In 1,295 consecutive patients undergoing 2,025 TFESI procedures, immediate AEs and delayed AEs occurred after 182 (9.2%) and 305 (20.0%) injections, respectively. The most common immediate AEs were: vasovagal reaction (4.2%) and interrupted procedure from intravascular flow (1.7%). Common delayed AEs included: pain exacerbation (5.0%), injection site soreness (3.9%), headache (3.9%), facial flushing/sweating (1.8%), and insomnia (1.6%). Significant associations were identified between AEs and gender, age, preprocedure VAS, steroid type, and fluoroscopy time. Trainee involvement in the procedure did not impact the complication rate.
  
  
  CONCLUSIONS
  Fluoroscopically guided lumbosacral TFESI is associated with a similar rate of minor AEs both immediately and 24 to 72 hours after procedure that are typical of other axial corticosteroid injections. Permanent AEs were not found in this sample. The most common AEs associated with TFESI include vasovagal episodes, procedure interruption from intravascular flow, pain exacerbation, injection site soreness, headache, and insomnia.
authors.affiliation: Department of PM&R, University of Pennsylvania, 1800 Lombard Street, Philadelphia, PA, 19146, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Plastaras
authors.affiliation: Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, McGaw Medical Center, Northwestern University Feinberg School of Medicine, 240 E. Huron St., Chicago, IL, 60611, USA. Electronic address: zmccormi@gmail.com.
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: McCormick
authors.affiliation: College of Nursing, University of Florida, 1225 Center Drive Gainesville, FL 32610, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Garvan
authors.affiliation: Department of Neurological Surgery, Stony Brook Neurosciences Institute, 24 Research Way, Suite 200, East Setauket, NY 11733, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Macron
authors.affiliation: Department of Orthopaedics, Duke University Medical Center, 200 Trent Dr, Durham, NC 27710, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Lake Washington Sports and Spine, 1600 116th Avenue Northeast #206, Bellevue, WA 98004, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Chimes
authors.affiliation: Alegent Health Physical Medicine and Rehabilitation Clinic, 17021 Lakeside Hills Plaza Omaha, NE 68130, USA.
authors.forename: Wesley
authors.initials: W
authors.lastname: Smeal
authors.affiliation: Department of Physical Medicine and Rehabilitation, Kaiser Permanente, 3701 Broadway, 5th floor, Oakland, CA 94611, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Rittenberg
authors.affiliation: Department of Orthopaedics, Stanford University, 450 Broadway Street Pavilion C, 4th Floor Redwood City, CA 94063, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kennedy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects / Q000379:methods; D017116:Low Back Pain / Q000188:drug therapy*; D008161:Lumbosacral Region / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D013256:Steroids
keywords: Adverse effects; Complications; Epidural; Fluoroscopic injection; Steroid injection; Transforaminal