scholarly journals Factfinders for patient safety: Antithrombotics and interventional pain procedures -- lumbar transforaminal epidural steroid injections and lumbar medial branch radiofrequency neurotomy

2021 ◽  
pp. 100008
Author(s):  
Clark Smith ◽  
David C. Miller ◽  
Mathew Saffarian ◽  
Zachary L. McCormick
Keyword(s):  
Patient Safety ◽  
Medial Branch ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Radiofrequency Neurotomy ◽  
Epidural Steroid

Antiplatelet and Anticoagulant Risk for Select Spine Interventions: A Retrospective Cohort

Pain Medicine ◽  
2020 ◽  
Vol 21 (5) ◽  
pp. 910-917
Author(s):  
Reza Ehsanian ◽  
Renee M Rosati ◽  
David J Kennedy ◽  
Byron J Schneider
Keyword(s):  
Epidural Hematoma ◽  
Facet Joint ◽  
Anticoagulant Effect ◽  
Bleeding Complications ◽  
Medial Branch ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Clinical Encounters ◽  
Epidural Steroid ◽  
Joint Injections

Abstract Objectives To identify significant bleeding complications following spinal interventions in patients taking medications with antiplatelet or anticoagulation effect. Design Retrospective chart review of a 12-month period. Setting Outpatient academic medical practice. Interventions Injections during outpatient interventional spine clinical encounters, including 14 cervical transforaminal epidural steroid injections, 26 cervical medial branch blocks, seven cervical radiofrequency neurotomies, three cervical facet joint injections, 88 lumbar transforaminal epidural steroid injections, 66 lumbosacral medial branch blocks, 18 lumbosacral radiofrequency neurotomies, 13 lumbar facet joint injections, one caudal epidural steroid injection, 11 sacral transforaminal epidural steroid injections, and 32 sacroiliac joint injections. Main Outcome Measure Epidural hematoma or other serious bleeding. Results In this cohort of 275 consecutive encounters with available records in which patients underwent a spinal injection while continuing medications with antiplatelet or anticoagulant effect, zero of the 275 clinical encounters (0%, 95% confidence interval = 0–1.4%) resulted in epidural hematoma or other serious bleeding. For antiplatelet medication, nonsteroidal anti-inflammatory drugs were continued in 102 procedures, aspirin in 142, clopidogrel in 21, and meloxicam and/or Celebrex in 81; for anticoagulation medication, warfarin was continued in four procedures, apixaban in six, dabigatran in one, and fondaparinux in two. Of note, one patient suffered a deep vein thrombosis, which was identified at two-week follow-up despite continuing aspirin therapy. Conclusions This cohort adds to the growing evidence that the risk of serious bleeding complications from select spine interventions while continuing medications with antiplatelet or anticoagulant effect appears low.

Interpreting Reviews and Guidelines: The Case of Lumbar Epidural Steroid Injections

PM&R ◽  
2009 ◽  
Vol 1 (6) ◽  
pp. 576-579 ◽  
Author(s):  
Venu Akuthota ◽  
Charles Argoff ◽  
William C. Watters
Keyword(s):  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

Transforaminal Lumbar and Thoracic Interventions and Ischemic Spinal Cord Injury

2016 ◽  
Author(s):  
Scott E. Glaser ◽  
Rinoo Shah
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Infarction ◽  
Supporting Evidence ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Root Cause ◽  
Cord Injury ◽  
Epidural Steroid ◽  
Ischemic Spinal Cord Injury

Transforaminal epidural steroid injections have been shown to be associated with catastrophic neurologic complications secondary to spinal cord infarction. The reflexive, ad hoc response of practitioners to these injuries has been to recommend risk minimization strategies to prevent embolism of the injected particulate steroids and to use nonparticulate steroids. This focus on distal embolism as the sole or primary cause of catastrophic outcomes lacks conclusive supporting evidence and does not suffice to protect the patient from paraplegia as it fails to address the root cause of the complications. A root cause analysis of the procedure provides evidence that the injection technique itself—the “safe triangle”—creates a risk of arterial damage and sequelae leading to ischemia of the spinal cord. The evidence is strong that the only way to mitigate or eliminate the risk of paraplegia is to use a different technique to perform transforaminal injections: the Kambin triangle approach. This change in technique is the only definitive solution that addresses the root cause of these catastrophic sequelae associated with transforaminal epidural steroid injections. Key Words: Artery of Adamkiewicz, ischemic spinal cord injury, Kambin triangle, safe triangle, transforaminal epidural injection

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