Few Same-Day Interventional Spine Complications

Interventional spine procedures have low same-day complication rates, according to an analysis of 26,151 such procedures performed at several centers in the United States. Less than 0.1% of the procedures resulted in a transfer to an emergency department (ED) or an aborted procedure, according to a presentation at the International Spine Intervention Society’s (ISIS) annual scientific meeting.

The investigators undertook the study because of the wide variation in adverse-event rates reported in the literature and reports of some serious sequelae from interventional spine procedures, including paralysis. They examined three quality-assurance databases: the Department of Radiology, Mayo Clinic, in Rochester, Minn.; the Rehabilitation Institute of Chicago (RIC), Northwestern Memorial Hospital; and the Department of Physical Medicine and Rehabilitation, Penn Spine Center, University of Pennsylvania, in Philadelphia.

The review included the following procedures at the three locations, respectively: 19,170 epidural steroid, facet and sacroiliac injections between 2006 and 2013; 6,280 epidural steroid, facet, sacroiliac, medial branch block injections and medial branch radiofrequency neurotomies between 2004 and 2009; and 701 epidural steroid, facet, sacroiliac, medial branch block injections and medial branch radiofrequency neurotomies in 2009-2010. The procedures were performed primarily with 22- or 25-gauge needles, rare use of sedation and with trainees frequently present and/or participating.

The total rate of verified, same-day complications was 1.9% or 493 events, with 289 (58.6% or 1.1% overall) being short-term vasovagal reactions to the injections. Of the procedures, 163 (0.6%) were aborted, 20 (<0.1%) resulted in a transfer to the ED, and 10 (<0.1%) were dural punctures.

Most of the aborted procedures were epidurals, with more being transforaminal epidural steroid injections rather than interlaminar epidural steroid injections. The primary causes for stopping the procedures were pain, vascular uptake of the injected medications and severe vasovagal reactions. The ED transfers were due to severe allergic or vasovagal reactions, chest pain and symptomatic hypertension. Allergic reactions occurred to both iodine-based contrast and gadolinium, and most were rashes with one laryngospasm.

The percentages were roughly similar across the institutions. There were no major complications such as permanent neurologic deficit.

“This study demonstrates that interventional pain procedures are safely performed with extremely low complication rates when evidence-based guidelines are observed,” said lead investigator Carrie Carr, MD, senior associate consultant, Department of Radiology, Mayo Clinic. Dr. Carr was slated to give the presentation but was on maternity leave. Researcher David J. Kennedy, MD, clinical assistant professor, Orthopaedic Surgery, Stanford University School of Medicine, in Palo Alto, Calif., did instead.