Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group

Koen Van Boxem*, Mienke Rijsdijk, Guy Hans, Jasper de Jong, Jan Willem Kallewaard, Kris Vissers, Maarten van Kleef, James P. Rathmell, Jan Van Zundert

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Background Epidural corticosteroid injections are used frequently worldwide in the treatment of radicular pain. Concerns have arisen involving rare major neurologic injuries after this treatment. Recommendations to prevent these complications have been published, but local implementation is not always feasible due to local circumstances, necessitating local recommendations based on literature review. Methods A work group of 4 stakeholder pain societies in Belgium, The Netherlands, and Luxembourg (Benelux) has reviewed the literature involving neurological complications after epidural corticosteroid injections and possible safety measures to prevent these major neurologic injuries. Results Twenty-six considerations and recommendations were selected by the work group. These involve the use of imaging, injection equipment particulate and nonparticulate corticosteroids, epidural approach, and maximal volume to be injected. Conclusion Raising awareness about possible neurological complications and adoption of safety measures recommended by the work group aim at reducing the risks for these devastating events.

Original languageEnglish
Pages (from-to)61-92
Number of pages32
JournalPain Practice
Volume19
Issue number1
DOIs
Publication statusPublished - Jan 2019

Keywords

  • epidural
  • corticosteroid
  • complications
  • dexamethasone
  • safe use
  • LUMBAR RADICULAR PAIN
  • CERVICAL TRANSFORAMINAL INJECTION
  • INTRATHECAL METHYLPREDNISOLONE ACETATE
  • DIGITAL-SUBTRACTION-ANGIOGRAPHY
  • BONE-MINERAL DENSITY
  • SPINAL-CORD-INJURY
  • NERVE ROOT BLOCKS
  • LOW-BACK-PAIN
  • STEROID INJECTIONS
  • DOUBLE-BLIND

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