Physical Medicine and Rehabilitation (90)

Abstract

Complications of fluoroscopically guided transformational lumbar epidural injections. (Florida Spine Institute, Clearwater, FL) Arch Phys Med Rehabil 2000;81:1045–1050.This retrospective cohort design study assessed the incidence of complications of fluoroscopically guided lumbar transformational epidural injections at a multidisciplinary spine care center. Patients presenting with radiculopathy caused by either lumbar spinal stenosis or herniated nucleus pulposus confirmed by magnetic resonance imaging or computed tomography scanning received transformational epidural steroid injections as part of a conservative care treatment plan. All injections were performed consecutively over a 4‐month period by 5 physiatrists. An independent observer reviewed medical charts, which included a 24‐h postprocedure telephone call by an ambulatory surgery center nurse who had asked questions from a standardized questionnaire about complications following the injections. Physician follow‐up office notes 1 to 3 weeks after the injection, along with epiduragrams, were also reviewed. Two hundred seven patients who received 322 injections were reviewed. Complications per injection seen included 10 transient nonpositional headaches that resolved within 24 h (3.1%), 8 increased back pain (2.4%), 2 increased leg pain (0.6%) 4 facial flushing (1.2%), 1 vasovagal reaction (0.3%), 1 increased blood sugar (258 mg/dL) in an insulin‐dependant diabetic (0.3%), and 1 intraoperative hypertension (0.3%). No dural punctures occurred. Conclude there were no major complications. The incidence of minor complication was 9.5% per injection. All reactions resolved without morbidity, and no patient required hospitalization.