Korean Journal of Radiology

  • 제19권2호
  • /
  • Pages.301-310
  • /
  • 2018
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

The Incidence of Various Types of Systemic Reactions Related to Epidural Steroid Injections: A Prospective Observational Study

  • Lee, Guen Young (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Lee, Joon Woo (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Yeom, Jin S. (Department of Orthopedic Surgery, Seoul National University Bundang Hospital) ;
  • Kim, Ki-Jeong (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Shin, Hyung-Ik (Department of Rehabilitation Medicine, Seoul National University Bundang Hospital) ;
  • Kang, Heung Sik (Department of Radiology, Seoul National University Bundang Hospital)
  • 투고 : 2017.01.09
  • 심사 : 2017.08.11
  • 발행 : 2018.04.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To evaluate the incidence, types and association of systemic reactions after an epidural steroid injection (ESI) with patient demographics, ESI factors and repeated occurrence of an ESI. Materials and Methods: This prospective observational study was approved by the Institutional Review Board of our hospital, and written informed consent was obtained from all the participants. From October to December 2011, systemic reactions at 2 weeks after 960 ESIs among 885 patients were measured. Patients were evaluated by phone interviews to obtain the patients' demographics, history of previous ESI, ESI factors, and ESI reoccurrence. Statistical analyses were performed using the chi-square tests, Fisher's exact tests and a binary logistic regression analysis. Results: Overall, 557 types of systemic reactions occurred after 292 injections (30.4%) of a total of 960 ESIs in which facial flushing was most common (131/557, 23.5%) and 144 ESIs were followed by a mixed form of systemic reactions (49.3%). Age of 62 years or younger (odds ratio [OR], 2.361), female sex (OR, 1.674), and history of diabetes mellitus (OR, 1.681) were significant risk factors in the occurrence of systemic reactions after an ESI. In 73 patients with repeated ESI, 14 patients re-experienced systemic reactions (19.2%), of which twelve re-experienced the same systemic reaction as the previous one. Conclusion: Systemic reactions followed about 30% of ESIs, and more commonly occurred in patients 62 years of age or younger, women, and diabetic patients. Half of the patients experienced a mixed form of systemic reactions. Patients with recurring systemic reactions tend to re-experience the same systemic reaction as the prior one after an ESI.

키워드

참고문헌

  1. Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain: time to back off? J Am Board Fam Med 2009;22:62-68 https://doi.org/10.3122/jabfm.2009.01.080102
  2. Manchikanti L, Pampati V, Falco FJ, Hirsch JA. Growth of spinal interventional pain management techniques: analysis of utilization trends and Medicare expenditures 2000 to 2008. Spine (Phila Pa 1976) 2013;38:157-168 https://doi.org/10.1097/BRS.0b013e318267f463
  3. Manchikanti L, Singh V, Pampati V, Smith HS, Hirsch JA. Analysis of growth of interventional techniques in managing chronic pain in the Medicare population: a 10-year evaluation from 1997 to 2006. Pain Physician 2009;12:9-34
  4. Buenaventura RM, Datta S, Abdi S, Smith HS. Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician 2009;12:233-251
  5. Conn A, Buenaventura RM, Datta S, Abdi S, Diwan S. Systematic review of caudal epidural injections in the management of chronic low back pain. Pain Physician 2009;12:109-135
  6. Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician 2007;10:185-212
  7. Boswell MV, Colson JD, Sehgal N, Dunbar EE, Epter R. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician 2007;10:229-253
  8. Waldman SD. Complications of cervical epidural nerve blocks with steroids: a prospective study of 790 consecutive blocks. Reg Anesth 1989;14:149-151
  9. Slipman CW, Meyers JS, Chou LH, Sterenfeld EB, Abrams S. Complications of fluoroscopically guided spinal injections (abstract). Arch Phys Med Rehabil 1995;76:1032
  10. Huston CW, Slipman CW, Meyers JS, Yang ST, Anghel BN. Side effects and complications of fluoroscopically guided nerve root injections (abstract). Arch Phys Med Rehabil 1996;77:937
  11. Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Freeman TL, Slaten WK. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil 2000;81:1045-1050 https://doi.org/10.1053/apmr.2000.7166
  12. Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Hanna A, Rittenberg J, et al. Complications of fluoroscopically guided caudal epidural injections. Am J Phys Med Rehabil 2001;80:416-424 https://doi.org/10.1097/00002060-200106000-00005
  13. Botwin KP, Castellanos R, Rao S, Hanna AF, Torres-Ramos FM, Gruber RD, et al. Complications of fluoroscopically guided interlaminar cervical epidural injections. Arch Phys Med Rehabil 2003;84:627-633
  14. Derby R, Lee SH, Kim BJ, Chen Y, Seo KS. Complications following cervical epidural steroid injections by expert interventionalists in 2003. Pain Physician 2004;7:445-449
  15. Huston CW, Slipman CW, Garvin C. Complications and side effects of cervical and lumbosacral selective nerve root injections. Arch Phys Med Rehabil 2005;86:277-283 https://doi.org/10.1016/j.apmr.2004.02.018
  16. Pobiel RS, Schellhas KP, Eklund JA, Golden MJ, Johnson BA, Chopra S, et al. Selective cervical nerve root blockade: prospective study of immediate and longer term complications. AJNR Am J Neuroradiol 2009;30:507-511 https://doi.org/10.3174/ajnr.A1415
  17. Karaman H, Kavak GO, Tufek A, Yldrm ZB. The complications of transforaminal lumbar epidural steroid injections. Spine (Phila Pa 1976) 2011;36:E819-E824 https://doi.org/10.1097/BRS.0b013e3181f32bae
  18. McGrath JM, Schaefer MP, Malkamaki DM. Incidence and characteristics of complications from epidural steroid injections. Pain Med 2011;12:726-731 https://doi.org/10.1111/j.1526-4637.2011.01077.x
  19. Manchikanti L, Malla Y, Wargo BW, Cash KA, Pampati V, Fellows B. Complications of fluoroscopically directed facet joint nerve blocks: a prospective evaluation of 7,500 episodes with 43,000 nerve blocks. Pain Physician 2012;15:E143-E150
  20. Manchikanti L, Malla Y, Wargo BW, Cash KA, Pampati V, Fellows B. A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections. Pain Physician 2012;15:131-140
  21. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007;147:573-577 https://doi.org/10.7326/0003-4819-147-8-200710160-00010
  22. Simopoulos TT, Kraemer JJ, Glazer P, Bajwa ZH. Vertebral osteomyelitis: a potentially catastrophic outcome after lumbar epidural steroid injection. Pain Physician 2008;11:693-697
  23. Ain RJ, Vance MB. Epidural hematoma after epidural steroid injection in a patient withholding enoxaparin per guidelines. Anesthesiology 2005;102:701-703
  24. Xu R, Bydon M, Gokaslan ZL, Wolinsky JP, Witham TF, Bydon A. Epidural steroid injection resulting in epidural hematoma in a patient despite strict adherence to anticoagulation guidelines. J Neurosurg Spine 2009;11:358-364 https://doi.org/10.3171/2009.3.SPINE0916
  25. MacLean CA, Bachman DT. Documented arterial gas embolism after spinal epidural injection. Ann Emerg Med 2001;38:592-595 https://doi.org/10.1067/mem.2001.118008
  26. Ludwig MA, Burns SP. Spinal cord infarction following cervical transforaminal epidural injection: a case report. Spine (Phila Pa 1976) 2005;30:E266-E268 https://doi.org/10.1097/01.brs.0000162401.47054.00
  27. Muro K, O'Shaughnessy B, Ganju A. Infarction of the cervical spinal cord following multilevel transforaminal epidural steroid injection: case report and review of the literature. J Spinal Cord Med 2007;30:385-388 https://doi.org/10.1080/10790268.2007.11753957
  28. Suresh S, Berman J, Connell DA. Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block. Skeletal Radiol 2007;36:449-452 https://doi.org/10.1007/s00256-006-0215-0
  29. Lyders EM, Morris PP. A case of spinal cord infarction following lumbar transforaminal epidural steroid injection: MR imaging and angiographic findings. AJNR Am J Neuroradiol 2009;30:1691-1693 https://doi.org/10.3174/ajnr.A1567
  30. Popescu A, Lai D, Lu A, Gardner K. Stroke following epidural injections--case report and review of literature. J Neuroimaging 2013;23:118-121 https://doi.org/10.1111/j.1552-6569.2011.00615.x
  31. Kushner FH, Olson JC. Retinal hemorrhage as a consequence of epidural steroid injection. Arch Ophthalmol 1995;113:309-313 https://doi.org/10.1001/archopht.1995.01100030065023
  32. Young WF. Transient blindness after lumbar epidural steroid injection: a case report and literature review. Spine (Phila Pa 1976) 2002;27:E476-E477 https://doi.org/10.1097/00007632-200211010-00022
  33. Browning DJ. Acute retinal necrosis following epidural steroid injections. Am J Ophthalmol 2003;136:192-194 https://doi.org/10.1016/S0002-9394(03)00095-3
  34. Bhat AL, Chow DW, DePalma MJ, Garvan C, Chou L, Lenrow D, et al. Incidence of vocal cord dysfunction after fluoroscopically guided steroid injections in the axial skeleton. Arch Phys Med Rehabil 2005;86:1330-1332 https://doi.org/10.1016/j.apmr.2004.11.042
  35. Everett CR, Baskin MN, Speech D, Novoseletsky D, Patel R. Flushing as a side effect following lumbar transforaminal epidural steroid injection. Pain Physician 2004;7:427-429
  36. Abbasi A, Roque-Dang CM, Malhotra G. Persistent hiccups after interventional pain procedures: a case series and review. PM R 2012;4:144-151 https://doi.org/10.1016/j.pmrj.2011.09.005
  37. Benyamin RM, Vallejo R, Kramer J, Rafeyan R. Corticosteroid induced psychosis in the pain management setting. Pain Physician 2008;11:917-920
  38. Sandberg DI, Lavyne MH. Symptomatic spinal epidural lipomatosis after local epidural corticosteroid injections: case report. Neurosurgery 1999;45:162-165
  39. Goodman BS, Bayazitoglu M, Mallempati S, Noble BR, Geffen JF. Dural puncture and subdural injection: a complication of lumbar transforaminal epidural injections. Pain Physician 2007;10:697-705
  40. Candido KD, Katz JA, Chinthagada M, McCarthy RA, Knezevic NN. Incidence of intradiscal injection during lumbar fluoroscopically guided transforaminal and interlaminar epidural steroid injections. Anesth Analg 2010;110:1464-1467 https://doi.org/10.1213/ANE.0b013e3181d6bd12
  41. Zufferey P, Bulliard C, Gremion G, Saugy M, So A. Systemic effects of epidural methylprednisolone injection on glucose tolerance in diabetic patients. BMC Res Notes 2011;4:552 https://doi.org/10.1186/1756-0500-4-552
  42. Gonzalez P, Laker SR, Sullivan W, Harwood JE, Akuthota V. The effects of epidural betamethasone on blood glucose in patients with diabetes mellitus. PM R 2009;1:340-345 https://doi.org/10.1016/j.pmrj.2008.12.007
  43. Even JL, Crosby CG, Song Y, McGirt MJ, Devin CJ. Effects of epidural steroid injections on blood glucose levels in patients with diabetes mellitus. Spine (Phila Pa 1976) 2012;37:E46-E50 https://doi.org/10.1097/BRS.0b013e31821fd21f

피인용 문헌

  1. Devastating Vertebral Osteomyelitis After Epidural Steroid Injection : A Case Report vol.9, pp.4, 2019, https://doi.org/10.2106/jbjs.cc.19.00028
  2. A Glimpse on Trends and Characteristics of Recent Articles Published in the Korean Journal of Radiology vol.20, pp.12, 2019, https://doi.org/10.3348/kjr.2019.0928
  3. Systemic effects of fluoroscopically guided epidural steroid injection with dexamethasone vol.32, pp.3, 2018, https://doi.org/10.3344/kjp.2019.32.3.178
  4. Intra-articular facet joint steroid injection-related adverse events encountered during 11,980 procedures vol.30, pp.3, 2018, https://doi.org/10.1007/s00330-019-06483-3
  5. Changes in the medical burden of pyogenic and tuberculous spondylitis between 2007 and 2016: A nationwide cohort study vol.73, pp.None, 2018, https://doi.org/10.1016/j.jocn.2020.01.023