Safety of cervical transforaminal epidural steroid injections

Factfinders for patient safety: Epidural steroid injections in the setting of severe cervical central and neuroforaminal stenosis

This FactFinder presents a brief summary of the evidence surrounding the safety of epidural steroid injections in patients with severe cervical central canal or neural foraminal stenosis. With proper consideration of anatomy, level, and approach, cervical epidural steroid injection risks may be mitigated in a patient with severe cervical central canal and/or neuroforaminal spinal stenosis.

Risks and Benefits of Cervical Transforaminal Epidural Steroid Injections: A Comprehensive Review

PURPOSE OF REVIEW

Cervical transforaminal epidural steroid injections (CTFESIs) are widely used for the treatment of radicular pain caused by cervical spine pathology, including disc herniations and foraminal stenosis. This review aims to analyze the risks and benefits of CTFESIs, address their efficacy and safety profile, improve clinical decision-making, and educate interventional pain medicine physicians.

RECENT FINDINGS

CTFESIs have demonstrated benefits such as pain relief, functional improvement, and the potential to avoid surgical interventions. However, their use is limited by safety concerns due to the proximity of vascular structures in the cervical spine. Complications, including neurological injuries, infections, and vascular injuries, though rare, can be severe. Recent studies emphasize the importance of using advanced procedural techniques, such as fluoroscopic guidance and non-particulate corticosteroids, to minimize risks. CTFESIs remain a valuable tool for managing cervical radiculopathy in selected patients. While they provide substantial therapeutic and diagnostic benefits, careful patient selection and adherence to safety protocols are crucial to minimizing serious complications. This review compiles current evidence to assist clinicians in evaluating the risks and benefits of CTFESIs in clinical practice.