Complications of fluoroscopically guided transforaminal lumbar epidural injections

Objectives: To assess the incidence of complications of fluoroscopically gu ided lumbar transforaminal epidural injections. Design: A retrospective cohort design study. Patients presenting with radic ulopathy, caused by either lumbar spinal stenosis or herniated nucleus pulp osus confirmed by magnetic resonance imaging or computed tomography scannin g, received transforaminal epidural steroid injections as part of a conserv ative care treatment plan. Setting: A multidisciplinary spine care center. Intervention: All injections were performed consecutively over a 4-month pe riod by five physiatrists. An independent observer reviewed medical charts, which included a 24-hour postprocedure telephone call by an ambulatory sur gery center nurse who had asked a standardized questionnaire about complica tions following the injections. Physician follow-up office notes I to 3 wee ks after the injection, along with epiduragrams, were also reviewed. Results: Two hundred seven patients who received 322 injections were review ed. Complications per injection seen included 10 transient nonpositional he adaches that resolved within 24 hours (3.1%), 8 increased back pain (2.4%), 2 increased leg pain (0.6%), 4 facial flushing (1.2%), 1 vasovagal reactio n (0.3%), 1 increased blood sugar (258mg/dL) in an insulin-dependent diabet ic (0.3%), and 1 intraoperative hypertension (0.3%). No dural punctures occ urred. Conclusions: There were no major complications. The incidence of minor comp lications was 9.6% per injection. All reactions resolved without morbidity, and no patient required hospitalization.