Severe Neurological and Systemic Adverse Events Following Cervical Epidural Steroid Injection: A Structured Review of Reported Clinical Cases, Anatomical Considerations, Pathophysiology, and Clinical Implications

Öz

Objective: The objective of this study was to map the clinical spectrum, timing, mechanisms, management, and outcomes of reported severe neurological and systemic complications following cervical epidural steroid injections (CESIs), and to correlate the reported events with transforaminal (TF) and interlaminar (IL) technical approaches. Methods: This study was designed as a case-based systematic review and descriptive synthesis. Thirty-two published reported cases were included. Extracted variables included study name and year, injection technique, drug or steroid category, complication type, onset timing, injection level, and management or outcome. Cases were classified according to injection technique, complication category, onset timing, steroid category, and outcome severity. The synthesis was conducted in accordance with PRISMA principles and the Synthesis Without Meta-analysis (SWiM) approach. Results: The analysis showed that the most frequent complication category was non-ischemic neurological, spinal cord, or nerve injury (34.4%). This was followed by vascular or ischemic neurological injury (18.8%), air-related complications (15.6%), hemorrhagic complications (12.5%), autonomic, cranial nerve, or systemic reactions (12.5%), and infectious or systemic complications (6.2%). Immediate or minutes-after-procedure onset was frequently documented. Persistent sequelae were reported in 21.9% of cases, death in 6.2%, and complete recovery in 25.0%. Conclusion: These findings suggest that reported TF complications are commonly associated with vascular or ischemic mechanisms, whereas reported IL complications are more often related to neuraxial access, including hematoma, pneumocephalus, and direct spinal cord or nerve injury. These results should be interpreted as patterns of reported harm rather than incidence estimates.

Anahtar Kelimeler

• Cervical epidural steroid injection
• Transforaminal injection
• Interlaminar injection
• Neurological complications
• Systematic review.

Servikal Epidural Steroid Enjeksiyonu Sonrası Gelişen Ciddi Nörolojik ve Sistemik Advers Olaylar: Bildirilmiş Klinik Olgular, Anatomik Değerlendirmeler, Patofizyoloji ve Klinik Çıkarımlar Üzerine Yapılandırılmış Bir Derleme

Öz

Amaç: Bu çalışmanın amacı, servikal epidural steroid enjeksiyonları sonrasında bildirilen ciddi nörolojik ve sistemik komplikasyonların klinik spektrumunu, ortaya çıkış zamanını, olası mekanizmalarını, yönetimini ve sonuçlarını incelemek; ayrıca bildirilen olayları transforaminal (TF) ve interlaminar (IL) teknik yaklaşımlarla ilişkilendirmekti. Yöntem: Çalışma, olgu temelli sistematik derleme ve tanımlayıcı sentez olarak tasarlandı. Literatürde yayımlanmış 32 olgu çalışmaya dahil edildi. Çalışmalardan yazar/yıl, enjeksiyon tekniği, kullanılan ilaç veya steroid kategorisi, komplikasyon tipi, başlangıç zamanı, enjeksiyon seviyesi ve yönetim/sonuç bilgileri çıkarıldı. Olgular teknik yaklaşım, komplikasyon kategorisi, başlangıç zamanı, steroid kategorisi ve sonuç şiddetine göre sınıflandırıldı. Sentez PRISMA ilkeleri ve Meta-analiz Olmadan Sentez (SWiM) yaklaşımı doğrultusunda gerçekleştirildi. Bulgular: Analizler sonucunda en sık komplikasyon kategorisinin iskemik olmayan nörolojik, omurilik veya sinir yaralanmaları olduğu bulundu (%34,4). Bunu vasküler veya iskemik nörolojik yaralanmalar (%18,8), hava ile ilişkili komplikasyonlar (%15,6), hemorajik komplikasyonlar (%12,5), otonomik, kraniyal sinir veya sistemik reaksiyonlar (%12,5) ve enfeksiyöz veya sistemik komplikasyonlar (%6,2) izledi. Komplikasyonların çoğunda başlangıcın işlemden hemen sonra veya dakikalar içinde meydana geldiği görüldü. Bildirilen olguların %21,9’unda kalıcı sekeller, %6,2’sinde ölüm ve %25,0’ında tam iyileşme tanımlandı. Sonuç: Bu bulgular ışığında, bildirilen TF komplikasyonlarının çoğunlukla vasküler veya iskemik mekanizmalarla ilişkili olduğu; IL komplikasyonlarının ise daha çok hematom, pnömosefali ve doğrudan omurilik veya sinir yaralanması gibi nöraksiyel erişimle ilişkili komplikasyonlar şeklinde ortaya çıktığı sonucuna varıldı. Ancak bu bulgular insidans tahminleri olarak değil, bildirilen zarar örüntülerini gösteren sonuçlar olarak değerlendirilmelidir.

Anahtar Kelimeler

• Servikal epidural steroid enjeksiyonu
• Transforaminal enjeksiyon
• İnterlaminar enjeksiyon
• Nörolojik komplikasyonlar
• Sistematik derleme.

Kaynakça

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