A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections

Pain Physician, 03/26/2012

This study illustrates that major complications are rare and minor side effects are common.


  • A prospective, non–randomized study of patients undergoing interventional techniques from May 2008 to December 2009.
  • A private interventional pain management practice, a specialty referral center in the United States.
  • To assess the complication rate of fluoroscopically directed epidural injections.
  • This study was carried out over a period of 20 months and included over 10,000 procedures: 39% caudal epidurals, 23% cervical interlaminar epidurals, 14% lumbar interlaminar epidurals, 13% lumbar transforaminal epidurals, 8% percutaneous adhesiolysis, and 3% thoracic interlaminar epidural procedures.
  • All of the interventions were performed under fluoroscopic guidance in an ambulatory surgery center by one of 3 physicians.
  • The complications encountered during the procedure and postoperatively were prospectively evaluated.


  • Intravascular entry was higher for adhesiolysis (11.6%) and lumbar transforaminal (7.9%) procedures compared to other epidurals which ranged from 0.5% for lumbar, 3.1% for caudal, 4% for thoracic, and 4.1% for cervical epidurals.
  • Dural puncture was observed in a total of 0.5% of the procedures with 1% in the cervical region, 1.3% in the thoracic region, 0.8% with lumbar interlaminar epidurals, and 1.8% with adhesiolysis.

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