Adverse Event Rates Associated with Transforaminal and Interlaminar Epidural Steroid Injections: A Multi-Institutional Study

Christine A. El-Yahchouchi, Christopher T. Plastaras, Timothy Maus, Carrie Carr, Zachary L. McCormick, Jennifer R. Geske, Matthew Smuck, Matthew J. Pingree, David J. Kennedy

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND: Transforaminal epidural steroid injections (TFESI) have demonstrated efficacy and effectiveness in treatment of radicular pain. Despite little evidence of efficacy/effectiveness, interlaminar epidural steroid injections (ILESI) are advocated by some as primary therapy for radicular pain due to purported greater safety.

OBJECTIVE: To assess immediate and delayed adverse event rates of TFESI and ILESI injections at three academic medical centers utilizing International Spine Intervention Society practice guidelines.

METHODS: Quality assurance databases from a Radiology and two physical medicine and rehabilitation (PM&R) practices were interrogated. Medical records were reviewed, verifying immediate and delayed adverse events.

RESULTS: There were no immediate major adverse events of neurologic injury or hemorrhage in 16,638 consecutive procedures in all spine segments (14,956 TFESI; 1,682 ILESI). Vasovagal reactions occurred in 1.2% of procedures, more frequently (P = 0.004) in TFESI (1.3%) than ILESI (0.5%). Dural punctures occurred in 0.06% of procedures, more commonly after ILESI (0.2% vs 0.04%, P = 0.006). Delayed follow up on PM&R patients (92.5% and 78.5, next business day) and radiology patients (63.1%, 2 weeks) identified no major adverse events of neurologic injury, hemorrhage, or infection. There were no significant differences in delayed minor adverse event rates. Central steroid response (sleeplessness, flushing, nonpositional headache) was seen in 2.6% of both TFESI and ILESI patients. 2.1% of TFESI and 1.8% of ILESI patients reported increased pain. No long-term sequelae were seen from any immediate or delayed minor adverse event.

CONCLUSIONS: Both transforaminal and ILESI are safely performed with low immediate and delayed adverse event rates when informed by evidence-based procedural guidelines. By demonstrating comparable safety, this study suggests that the choice between ILESI and TFESIs can be based on documented efficacy and effectiveness and not driven by safety concerns.

Original languageEnglish (US)
Pages (from-to)239-249
Number of pages11
JournalPain medicine (Malden, Mass.)
Volume17
Issue number2
StatePublished - Feb 1 2016

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Epidural Injections
Steroids
Nervous System Trauma
Safety
Radiology
Pain
Spine
Hemorrhage
Physical and Rehabilitation Medicine
Sleep Initiation and Maintenance Disorders

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

El-Yahchouchi, C. A., Plastaras, C. T., Maus, T., Carr, C., McCormick, Z. L., Geske, J. R., ... Kennedy, D. J. (2016). Adverse Event Rates Associated with Transforaminal and Interlaminar Epidural Steroid Injections: A Multi-Institutional Study. Pain medicine (Malden, Mass.), 17(2), 239-249.

Adverse Event Rates Associated with Transforaminal and Interlaminar Epidural Steroid Injections : A Multi-Institutional Study. / El-Yahchouchi, Christine A.; Plastaras, Christopher T.; Maus, Timothy; Carr, Carrie; McCormick, Zachary L.; Geske, Jennifer R.; Smuck, Matthew; Pingree, Matthew J.; Kennedy, David J.

In: Pain medicine (Malden, Mass.), Vol. 17, No. 2, 01.02.2016, p. 239-249.

Research output: Contribution to journalArticle

El-Yahchouchi, CA, Plastaras, CT, Maus, T, Carr, C, McCormick, ZL, Geske, JR, Smuck, M, Pingree, MJ & Kennedy, DJ 2016, 'Adverse Event Rates Associated with Transforaminal and Interlaminar Epidural Steroid Injections: A Multi-Institutional Study', Pain medicine (Malden, Mass.), vol. 17, no. 2, pp. 239-249.
El-Yahchouchi, Christine A. ; Plastaras, Christopher T. ; Maus, Timothy ; Carr, Carrie ; McCormick, Zachary L. ; Geske, Jennifer R. ; Smuck, Matthew ; Pingree, Matthew J. ; Kennedy, David J. / Adverse Event Rates Associated with Transforaminal and Interlaminar Epidural Steroid Injections : A Multi-Institutional Study. In: Pain medicine (Malden, Mass.). 2016 ; Vol. 17, No. 2. pp. 239-249.
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abstract = "BACKGROUND: Transforaminal epidural steroid injections (TFESI) have demonstrated efficacy and effectiveness in treatment of radicular pain. Despite little evidence of efficacy/effectiveness, interlaminar epidural steroid injections (ILESI) are advocated by some as primary therapy for radicular pain due to purported greater safety.OBJECTIVE: To assess immediate and delayed adverse event rates of TFESI and ILESI injections at three academic medical centers utilizing International Spine Intervention Society practice guidelines.METHODS: Quality assurance databases from a Radiology and two physical medicine and rehabilitation (PM&R) practices were interrogated. Medical records were reviewed, verifying immediate and delayed adverse events.RESULTS: There were no immediate major adverse events of neurologic injury or hemorrhage in 16,638 consecutive procedures in all spine segments (14,956 TFESI; 1,682 ILESI). Vasovagal reactions occurred in 1.2{\%} of procedures, more frequently (P = 0.004) in TFESI (1.3{\%}) than ILESI (0.5{\%}). Dural punctures occurred in 0.06{\%} of procedures, more commonly after ILESI (0.2{\%} vs 0.04{\%}, P = 0.006). Delayed follow up on PM&R patients (92.5{\%} and 78.5, next business day) and radiology patients (63.1{\%}, 2 weeks) identified no major adverse events of neurologic injury, hemorrhage, or infection. There were no significant differences in delayed minor adverse event rates. Central steroid response (sleeplessness, flushing, nonpositional headache) was seen in 2.6{\%} of both TFESI and ILESI patients. 2.1{\%} of TFESI and 1.8{\%} of ILESI patients reported increased pain. No long-term sequelae were seen from any immediate or delayed minor adverse event.CONCLUSIONS: Both transforaminal and ILESI are safely performed with low immediate and delayed adverse event rates when informed by evidence-based procedural guidelines. By demonstrating comparable safety, this study suggests that the choice between ILESI and TFESIs can be based on documented efficacy and effectiveness and not driven by safety concerns.",
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T2 - A Multi-Institutional Study

AU - El-Yahchouchi, Christine A.

AU - Plastaras, Christopher T.

AU - Maus, Timothy

AU - Carr, Carrie

AU - McCormick, Zachary L.

AU - Geske, Jennifer R.

AU - Smuck, Matthew

AU - Pingree, Matthew J.

AU - Kennedy, David J.

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N2 - BACKGROUND: Transforaminal epidural steroid injections (TFESI) have demonstrated efficacy and effectiveness in treatment of radicular pain. Despite little evidence of efficacy/effectiveness, interlaminar epidural steroid injections (ILESI) are advocated by some as primary therapy for radicular pain due to purported greater safety.OBJECTIVE: To assess immediate and delayed adverse event rates of TFESI and ILESI injections at three academic medical centers utilizing International Spine Intervention Society practice guidelines.METHODS: Quality assurance databases from a Radiology and two physical medicine and rehabilitation (PM&R) practices were interrogated. Medical records were reviewed, verifying immediate and delayed adverse events.RESULTS: There were no immediate major adverse events of neurologic injury or hemorrhage in 16,638 consecutive procedures in all spine segments (14,956 TFESI; 1,682 ILESI). Vasovagal reactions occurred in 1.2% of procedures, more frequently (P = 0.004) in TFESI (1.3%) than ILESI (0.5%). Dural punctures occurred in 0.06% of procedures, more commonly after ILESI (0.2% vs 0.04%, P = 0.006). Delayed follow up on PM&R patients (92.5% and 78.5, next business day) and radiology patients (63.1%, 2 weeks) identified no major adverse events of neurologic injury, hemorrhage, or infection. There were no significant differences in delayed minor adverse event rates. Central steroid response (sleeplessness, flushing, nonpositional headache) was seen in 2.6% of both TFESI and ILESI patients. 2.1% of TFESI and 1.8% of ILESI patients reported increased pain. No long-term sequelae were seen from any immediate or delayed minor adverse event.CONCLUSIONS: Both transforaminal and ILESI are safely performed with low immediate and delayed adverse event rates when informed by evidence-based procedural guidelines. By demonstrating comparable safety, this study suggests that the choice between ILESI and TFESIs can be based on documented efficacy and effectiveness and not driven by safety concerns.

AB - BACKGROUND: Transforaminal epidural steroid injections (TFESI) have demonstrated efficacy and effectiveness in treatment of radicular pain. Despite little evidence of efficacy/effectiveness, interlaminar epidural steroid injections (ILESI) are advocated by some as primary therapy for radicular pain due to purported greater safety.OBJECTIVE: To assess immediate and delayed adverse event rates of TFESI and ILESI injections at three academic medical centers utilizing International Spine Intervention Society practice guidelines.METHODS: Quality assurance databases from a Radiology and two physical medicine and rehabilitation (PM&R) practices were interrogated. Medical records were reviewed, verifying immediate and delayed adverse events.RESULTS: There were no immediate major adverse events of neurologic injury or hemorrhage in 16,638 consecutive procedures in all spine segments (14,956 TFESI; 1,682 ILESI). Vasovagal reactions occurred in 1.2% of procedures, more frequently (P = 0.004) in TFESI (1.3%) than ILESI (0.5%). Dural punctures occurred in 0.06% of procedures, more commonly after ILESI (0.2% vs 0.04%, P = 0.006). Delayed follow up on PM&R patients (92.5% and 78.5, next business day) and radiology patients (63.1%, 2 weeks) identified no major adverse events of neurologic injury, hemorrhage, or infection. There were no significant differences in delayed minor adverse event rates. Central steroid response (sleeplessness, flushing, nonpositional headache) was seen in 2.6% of both TFESI and ILESI patients. 2.1% of TFESI and 1.8% of ILESI patients reported increased pain. No long-term sequelae were seen from any immediate or delayed minor adverse event.CONCLUSIONS: Both transforaminal and ILESI are safely performed with low immediate and delayed adverse event rates when informed by evidence-based procedural guidelines. By demonstrating comparable safety, this study suggests that the choice between ILESI and TFESIs can be based on documented efficacy and effectiveness and not driven by safety concerns.

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