Major risks and complications of cervical epidural steroid injections: An updated review.
Major risks and complications of cervical epidural steroid injections: An updated review.
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DOI：
10.4103/sni.sni_85_18
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发表时间：
2018
影响因子：
--
通讯作者：
Epstein NE
中科院分区：
文献类型：
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作者：
Epstein NE
太多的患者，无论是否有明显的宫颈疾病，都不必要地接受宫颈硬膜外类固醇注射（CESI）。这些包括层间（ICESI）和经椎间孔ESI（TF-CESI）注射，这些注射未经美国食品药品监督管理局（FDA）批准，没有记录的长期疗效，并具有严重的风险和并发症。在这里，我们回顾了最近的报告的发病率和死亡率归因于各种类型的CESIS。主要并发症包括;硬膜外血肿、感染（脓肿/脑膜炎）、由于髓内（四肢轻瘫/四肢瘫痪）和血管内注射（例如，椎动脉注射导致脊髓、脑干和小脑中风）。导致中风的后一种注射通常归因于颗粒状类固醇物质（例如，在甲基强的松龙注射溶液中）栓塞到远端动脉分支中。颈部CESI/TF-CESI注射的并发症导致硬膜外血肿、新发神经功能缺损（髓内注射）或血管内注射导致脊髓、脑干和小脑卒中，这些并发症通常报告不足。有趣的是，现在可以在法医学文献中找到其他几例涉及CESI/TF-CESI不良事件的病例。颈部硬膜外注射（例如，CESI、ICESI和TF-CESI）未经FDA批准，不提供长期益处，并且正在进行最小适应症或无适应症。它们导致显著的发病率和死亡率，包括：硬膜外血肿、感染、无意的髓内脊髓注射或脊髓、脑干和小脑卒中。此外，保险公司越来越多地要求在批准最终手术之前进行这些注射，从而在某些情况下大大延迟了必要的手术干预，同时也使保险公司手中的患者遭受这些手术的额外危险。
Too many patients, with or without significant cervical disease, unnecessarily undergo cervical epidural steroid injections (CESIs). These include interlaminar (ICESI) and transforaminal ESI (TF-CESI) injections that are not Food and Drug Administration (FDA) approved, have no documented long-term efficacy, and carry severe risks and complications. Here we reviewed recent reports of morbidity and mortality attributed to the various types of CESIS. Major complications included; epidural hematomas, infection (abscess/meningitis), increased neurological deficits due to intramedullary (quadriparesis/quadriplegia), and intravascular injections (e.g., vertebral artery injections leading to cord, brain stem, and cerebellar strokes). The latter injections leading to strokes were typically attributed to the particulate steroid matter (e.g., within the methylprednisolone injection solution) that embolized into the distal arterial branches. Complications of cervical CESI/TF-CESI injections producing epidural hematoma, new neurological deficits (intramedullary injections), or intravascular injections resulting in strokes to the cord, brain stem, and cerebellum are often underreported. Interestingly, several other cases involving adverse events of CESI/TF-CESI may now be found in the medicolegal literature. Cervical epidural injecions (e.g., CESI, ICESI, and TF-CESI) which are not FDA approved, provide no long-term benefit, and are being performed for minimal to no indications. They contribute to significant morbidity and mortality, including; epidural hematomas, infection, inadvertent intramedullary cord injections or cord, brain stem, and cerebellar strokes. Furthermore, these injections are increasingly required by insurance carriers prior to granting permission for definitive surgery, thus significantly delaying in some cases necessary operative intervention, while also subjecting patients at the hands of the insurance companies, to the additional hazards of these procedures.