{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T18:45:02Z","timestamp":1792262702169,"version":"4.4.0"},"reference-count":22,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Despite the lack of FDA (Food and Drug Administration) approval, cervical and lumbar epidural spinal injections are frequently performed in the US to address back pain and\/or painful radiculopathy. The three major types of injections include; interlaminar\/translaminar (ESI), transforaminal (TFESI), or caudal injections. Notably, most studies document little to no clear short-term, and no long-term benefits\/efficacy for these injections vs. various placebos.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>More adverse events (AE) occurred with cervical\u00a9 rather than lumbar (L) injections, and more severe AE were attributed to C-TFESI vs. CESI injections.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>Acute post injection AE symptoms were observed immediately or within 72 post-injection hours. These symptoms included; hypotension, acute respiratory distress, chest pain, upper extremity numbness, weakness, paresthesias, paralysis, and fevers. More AE were attributed to cervical C-TFESI vs. cervical CESI. These AE included; intramedullary\/cord injections, intravascular injections (i.e. vertebral artery) resulting in brain stem\/cerebellar\/cord strokes, epidural abscess\/infection, confusion, epidural hematomas, intracranial hypotension, and\/or 6<jats:sup>th<\/jats:sup> nerve cranial palsies. AE for lumbar LESI\/L-TFESI included; infections\/abscess, epidural hematomas\/subdural hematomas, intravascular injections, cerebrospinal fluid (CSF) leaks\/dural tears (DT), and intracranial\/postural hypotension. Notably, the vast majority of studies showed little to no short-term, and no long-term benefits for cervical or lumbar ESI\/TFESI vs placebos (i.e. mostly consisting of normal saline alone, or saline plus local anesthesia).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>Epidural cervical and lumbar ESI or TFESI spinal injections demonstrated minimal to no short-term, and no long-term benefits for the treatment of cervical and\/or lumbar pain\/radiculopathy vs. placebos. Further, more AE were observed for cervical vs. lumbar epidural injections overall, with more AE usually seen with TFESI vs. ESI procedures.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_701_2024","type":"journal-article","created":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T10:47:14Z","timestamp":1726224434000},"page":"328","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Perspective: Risks\/adverse events for epidural spinal injections"],"prefix":"10.25259","volume":"15","author":[{"given":"Nancy E.","family":"Epstein","sequence":"first","affiliation":[{"name":"Professor of Clinical Neurosurgery, School of Medicine, State University of NY at Stony Brook and Editor-in-Chief Surgical Neurology International NY, USA, and c\/o Dr. Marc Agulnick, 1122 Franklin Avenue Suite 106, Garden City, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc 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