Long-Term Complications of Epidural Steroid Injections

Cerebral Venous Sinus Thrombosis After Lumbar Epidural Steroid Injection: A Case Report

Cerebral venous sinus thrombosis (CVST) is an exceedingly rare complication of epidural anesthesia, with only a handful of known cases after epidural steroid injection (ESI). We report a case of CVST in a 33-year-old male patient that presented with headache after lumbar ESI. His clinical status initially improved on anticoagulation in the intensive care unit. However, he had a sudden worsening of cerebral edema that required an emergent hemicraniectomy. Ultimately, the patient was pronounced dead by neurologic criteria. This case highlights the importance of keeping this rare but potentially fatal diagnosis in the differential even in lower-risk patient populations.

Complications following diagnostic and therapeutic sacroiliac joint region injections in horses: A study describing clinicians' experiences

BACKGROUND

There are no detailed data on complications of sacroiliac (SI) joint region injections or on the variability of the methods and circumstances of injections among clinicians.

OBJECTIVES

To describe complications following diagnostic, therapeutic and combined SI joint region injections and the details of how these are routinely performed by a large number of clinicians.

STUDY DESIGN

Cross-sectional questionnaire survey.

METHODS

Clinicians (members of American and European specialist colleges and veterinarians known to the authors), invited by email, who had performed ≥1 SI joint region injection, completed an online questionnaire. Data collected included the clinicians' experience in diagnostic, therapeutic and combined SI joint region injections, details of the injection technique, volume and substance used, and the type of complications seen following SI joint region anaesthesia, medications and combined injections, respectively. Descriptive data analysis was performed and the association between any complications seen and the clinicians' experience, technique, volume and substance used were assessed using binary logistic regression.

RESULTS

Of the 212 respondents, 110 had performed diagnostic, 187 therapeutic and 49 combined injections. More clinicians experienced complications after diagnostic (53/110) than after therapeutic (33/187) or combined (6/49) injections (p < 0.01). The most common complications were hindlimb weakness/ataxia after all types of injections (diagnostic: 44/110, 40%, 95% confidence interval [CI]: 30.8-49.8; therapeutic: 15/187, 8.0%, CI: 4.6-12.9; combined: 2/49, 4.1%, CI: 0.5-14.0). Death or horses requiring euthanasia were reported (after therapeutic injections: 5/187; diagnostic injections: 1/110).

MAIN LIMITATIONS

No prevalence of complications was established; no detailed descriptions of complications were available. Results may be influenced by selection and recall biases.

CONCLUSIONS

Complications were experienced by more clinicians following diagnostic injections than after therapeutic or combined SI joint region injections, but the types and distribution of complications were similar. Results should be interpreted considering the previous reports of low prevalence of complications.