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Complications of Interventional Therapy for the Management of Low Back Pain

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Spine Pain Care

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Abstract

Interventional treatments available to address chronic low back pain have grown in their variety, but every procedure has associated risks. Complications from interventional procedures can be divided into three broad categories: complications associated with all interventional techniques, complications arising from the employed medications, and complications unique to certain procedures. For interventional pain procedures, the most relevant medications include local anesthetics, steroids, and contrast agents. Each of these medications can cause patient harm when overdose occurs, and at times, their inherent physical properties may also cause complications. Notwithstanding patient-related factors, the risk of any interventional pain procedure relates to the anatomical site involved and the type of instrumentation required. The practitioner must be aware of common and rare complications in context of all of these factors in order to implement measures to avoid them, as well as quickly identify and manage them should they occur. In addition, pain management physicians must be aware of all these possible complications so that an accurate risk-benefit discussion can be held with patients during the consent process. Further, patient care cannot truly be optimized unless practices are constantly refined to reduce the risk of possible complications.

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References

  1. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028–37.

    Article  PubMed  Google Scholar 

  2. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545–602.

    Article  Google Scholar 

  3. Chou R, Huffman LH. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):505–14.

    Article  PubMed  Google Scholar 

  4. Bogduk N. Practice guidelines for spinal diagnostic procedures. San Francisco: International Spine Intervention Society; 2013.

    Google Scholar 

  5. Carr CM, Plastaras CT, **ree MJ, Smuck M, Maus TP, Geske JR, et al. Immediate adverse events in interventional pain procedures: a multi-institutional study. Pain Med. 2016;17(12):2155–61.

    Article  PubMed  Google Scholar 

  6. Neal JM, Bernards CM, Butterworth JF, Di Gregorio G, Drasner K, Hejtmanek MR, et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. 2010;35(2):152–61.

    Article  PubMed  Google Scholar 

  7. Neal JM, Woodward CM, Harrison TK. The American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2017 version. Reg Anesth Pain Med. 2018;43(2):150–3.

    Article  PubMed  Google Scholar 

  8. Rathmell JP. Atlas of image-guided intervention in regional anesthesia and pain medicine. 2nd ed. Philidelphia: Lippincott Williams & Wilkins; 2011.

    Google Scholar 

  9. Tramer MR, von Elm E, Loubeyre P, Hauser C. Pharmacological prevention of serious anaphylactic reactions due to iodinated contrast media: systematic review. BMJ (Clinical Research ed). 2006;333(7570):675.

    Article  CAS  Google Scholar 

  10. Ward A, Watson J, Wood P, Dunne C, Kerr D. Glucocorticoid epidural for sciatica: metabolic and endocrine sequelae. Rheumatology (Oxford). 2002;41(1):68–71.

    Article  CAS  Google Scholar 

  11. Boonen S, Van Distel G, Westhovens R, Dequeker J. Steroid myopathy induced by epidural triamcinolone injection. Br J Rheumatol. 1995;34(4):385–6.

    Article  CAS  PubMed  Google Scholar 

  12. Kay J, Findling JW, Raff H. Epidural triamcinolone suppresses the pituitary-adrenal axis in human subjects. Anesth Analg. 1994;79(3):501–5.

    Article  CAS  PubMed  Google Scholar 

  13. Deer T, Ranson M, Kappural L, Diwan SA. Guidelines for the proper use of epidural steroid injections for the chronic pain patient. Tech Reg Anesth Pain Manag. 2009;13(4):288–95.

    Article  Google Scholar 

  14. Diehn FE, Murthy NS, Maus TP. Science to practice: what causes arterial infarction in transforaminal epidural steroid injections, and which steroid is safest? Radiology. 2016;279(3):657–9.

    Article  PubMed  Google Scholar 

  15. Derby R, Lee SH, Date ES, Lee JH, Lee CH. Size and aggregation of corticosteroids used for epidural injections. Pain Med. 2008;9(2):227–34.

    Article  PubMed  Google Scholar 

  16. Lento P, Ihm J, Kennedy DJ, Visco CJ. Peripheral joint and soft tissue injection techniques. 4th ed. Philadelphia: Elsevier; 2011.

    Google Scholar 

  17. Charles YP, Barbe B, Beaujeux R, Boujan F, Steib JP. Relevance of the anatomical location of the Adamkiewicz artery in spine surgery. Surg Radiol Anat. 2011;33(1):3–9.

    Article  PubMed  Google Scholar 

  18. Fitzgibbon DR, Posner KL, Domino KB, Caplan RA, Lee LA, Cheney FW. Chronic pain management: American Society of Anesthesiologists Closed Claims Project. Anesthesiology. 2004;100(1):98–105.

    Article  PubMed  Google Scholar 

  19. Narouze S, Benzon HT, Provenzano D, Buvanendran A, De Andres J, Deer T, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (second edition): guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med. 2018;43(3):225–62.

    PubMed  Google Scholar 

  20. Hooten WM, Kinney MO, Huntoon MA. Epidural abscess and meningitis after epidural corticosteroid injection. Mayo Clin Proc. 2004;79(5):682–6.

    Article  PubMed  Google Scholar 

  21. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000;23(4):175–204; discussion 5.

    Article  CAS  PubMed  Google Scholar 

  22. Hooten WM, Mizerak A, Carns PE, Huntoon MA. Discitis after lumbar epidural corticosteroid injection: a case report and analysis of the case report literature. Pain Med. 2006;7(1):46–51.

    Article  PubMed  Google Scholar 

  23. Houten JK, Errico TJ. Paraplegia after lumbosacral nerve root block: report of three cases. Spine J. 2002;2(1):70–5.

    Article  PubMed  Google Scholar 

  24. Benzon HT, Huntoon MA, Rathmell JP. Improving the safety of epidural steroid injections. JAMA. 2015;313(17):1713–4.

    Article  PubMed  Google Scholar 

  25. Rathmell JP, Benzon HT, Dreyfuss P, Huntoon M, Wallace M, Baker R, et al. Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology. 2015;122(5):974–84.

    Article  CAS  PubMed  Google Scholar 

  26. Landers MH. Spinal cord injury during attempted cervical interlaminar epidural injection of steroids. Pain Med. 2018;19(4):652–7.

    Article  PubMed  Google Scholar 

  27. Friedly J, Chan L, Deyo R. Increases in lumbosacral injections in the Medicare population: 1994 to 2001. Spine. 2007;32(16):1754–60.

    Article  PubMed  Google Scholar 

  28. Suri P, Miyakoshi A, Hunter DJ, Jarvik JG, Rainville J, Guermazi A, et al. Does lumbar spinal degeneration begin with the anterior structures? A study of the observed epidemiology in a community-based population. BMC Musculoskelet Disord. 2011;12:202.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Dreyfuss P, Schwarzer AC, Lau P, Bogduk N. Specificity of lumbar medial branch and L5 dorsal ramus blocks. A computed tomography study. Spine. 1997;22(8):895–902.

    Article  CAS  PubMed  Google Scholar 

  30. Cohen SP, Huang JH, Brummett C. Facet joint pain--advances in patient selection and treatment. Nat Rev Rheumatol. 2013;9(2):101–16.

    Article  PubMed  Google Scholar 

  31. Cohen SP, Moon JY, Brummett CM, White RL, Larkin TM. Medial branch blocks or intra-articular injections as a prognostic tool before lumbar facet radiofrequency denervation: a multicenter, case-control study. Reg Anesth Pain Med. 2015;40(4):376–83.

    Article  CAS  PubMed  Google Scholar 

  32. Smith M, Ferretti G, Mortazavi S. Radiographic changes induced after cervical facet radiofrequency denervation. Spine J. 2005;5(6):668–71.

    Article  PubMed  Google Scholar 

  33. Ogura T, Mikami Y, Hase H, Mori M, Hayashida T, Kubo T. Septic arthritis of a lumbar facet joint associated with epidural and paraspinal abscess. Orthopedics. 2005;28(2):173–5.

    Article  PubMed  Google Scholar 

  34. Weingarten TN, Hooten WM, Huntoon MA. Septic facet joint arthritis after a corticosteroid facet injection. Pain Med. 2006;7(1):52–6.

    Article  PubMed  Google Scholar 

  35. Kornick C, Kramarich SS, Lamer TJ, Todd SB. Complications of lumbar facet radiofrequency denervation. Spine. 2004;29(12):1352–4.

    Article  PubMed  Google Scholar 

  36. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106(3):591–614.

    Article  PubMed  Google Scholar 

  37. Van Boxem K, de Meij N, Kessels A, Van Kleef M, Van Zundert J. Pulsed radiofrequency for chronic intractable lumbosacral radicular pain: a six-month cohort study. Pain Med. 2015;16(6):1155–62.

    Article  PubMed  Google Scholar 

  38. Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005;101(5):1440–53.

    Article  PubMed  Google Scholar 

  39. Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Eichenseer PH, Sybert DR, Cotton JR. A finite element analysis of sacroiliac joint ligaments in response to different loading conditions. Spine. 2011;36(22):E1446–52.

    Article  PubMed  Google Scholar 

  41. Cohen SP, Hurley RW, Buckenmaier CC 3rd, Kurihara C, Morlando B, Dragovich A. Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology. 2008;109(2):279–88.

    Article  PubMed  Google Scholar 

  42. Vallejo R, Benyamin RM, Kramer J, Stanton G, Joseph NJ. Pulsed radiofrequency denervation for the treatment of sacroiliac joint syndrome. Pain Med. 2006;7(5):429–34.

    Article  PubMed  Google Scholar 

  43. Carragee EJ, Alamin TF. Discography: a review. Spine J. 2001;1(5):364–72.

    Article  CAS  PubMed  Google Scholar 

  44. Carragee EJ, Don AS, Hurwitz EL, Cuellar JM, Carrino JA, Herzog R. 2009 ISSLS prize winner: does discography cause accelerated progression of degeneration changes in the lumbar disc: a ten-year matched cohort study. Spine. 2009;34(21):2338–45.

    Article  PubMed  Google Scholar 

  45. Cuellar JM, Stauff MP, Herzog RJ, Carrino JA, Baker GA, Carragee EJ. Does provocative discography cause clinically important injury to the lumbar intervertebral disc? A 10-year matched cohort study. Spine J. 2016;16(3):273–80.

    Article  PubMed  Google Scholar 

  46. Willems PC, Jacobs W, Duinkerke ES, De Kleuver M. Lumbar discography: should we use prophylactic antibiotics? A study of 435 consecutive discograms and a systematic review of the literature. J Spinal Disord Tech. 2004;17(3):243–7.

    Article  PubMed  Google Scholar 

  47. Darmoul M, Bouhaouala MH, Rezgui M. Calcification following intradiscal injection, a continuing problem? Presse Med. 2005;34(12):859–60.

    Article  CAS  PubMed  Google Scholar 

  48. Kleinstueck FS, Diederich CJ, Nau WH, Puttlitz CM, Smith JA, Bradford DS, et al. Acute biomechanical and histological effects of intradiscal electrothermal therapy on human lumbar discs. Spine. 2001;26(20):2198–207.

    Article  CAS  PubMed  Google Scholar 

  49. Appleby D, Andersson G, Totta M. Meta-analysis of the efficacy and safety of intradiscal electrothermal therapy (IDET). Pain Med. 2006;7(4):308–16.

    Article  PubMed  Google Scholar 

  50. Desai MJ, Kapural L, Petersohn JD, Vallejo R, Menzies R, Creamer M, et al. Twelve-month follow-up of a randomized clinical trial comparing intradiscal biacuplasty to conventional medical management for discogenic lumbar back pain. Pain Med. 2017;18(4):751–63.

    PubMed  Google Scholar 

  51. Desai MJ, Kapural L, Petersohn JD, Vallejo R, Menzies R, Creamer M, et al. A prospective, randomized, multicenter, open-label clinical trial comparing intradiscal biacuplasty to conventional medical management for discogenic lumbar back pain. Spine. 2016;41(13):1065–74.

    Article  PubMed  Google Scholar 

  52. Bhagia SM, Slipman CW, Nirschl M, Isaac Z, El-Abd O, Sharps LS, et al. Side effects and complications after percutaneous disc decompression using coblation technology. Am J Phys Med Rehabil. 2006;85(1):6–13.

    Article  PubMed  Google Scholar 

  53. Li J, Yan DL, Zhang ZH. Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation. Eur Spine J. 2008;17(12):1664–9.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Brouwer PA, Brand R, van den Akker-van Marle ME, Jacobs WC, Schenk B, van den Berg-Huijsmans AA, et al. Percutaneous laser disc decompression versus conventional microdiscectomy for patients with sciatica: two-year results of a randomised controlled trial. Interv Neuroradiol. 2017;23(3):313–24.

    Article  PubMed  PubMed Central  Google Scholar 

  55. van den Akker-van Marle ME, Brouwer PA, Brand R, Koes B, van den Hout WB, van Buchem MA, et al. Percutaneous laser disc decompression versus microdiscectomy for sciatica: cost utility analysis alongside a randomized controlled trial. Interv Neuroradiol. 2017;23(5):538–45.

    Article  PubMed  PubMed Central  Google Scholar 

  56. McCormick ZL, Slipman C, Kotcharian A, Chhatre A, Bender FJ 3rd, Salam A, et al. Percutaneous lumbar disc decompression using the dekompressor: a prospective long-term outcome study. Pain Med. 2016;17:1023–30.

    Article  PubMed  Google Scholar 

  57. Alo KM, Wright RE, Sutcliffe J, Brandt SA. Percutaneous lumbar discectomy: one-year follow-up in an initial cohort of fifty consecutive patients with chronic radicular pain. Pain Pract. 2005;5(2):116–24.

    Article  PubMed  Google Scholar 

  58. Silber JS, Anderson DG, Vaccaro AR, Anderson PA, McCormick P. Management of postprocedural discitis. Spine J. 2002;2(4):279–87.

    Article  PubMed  Google Scholar 

  59. Fitzgibbon DR, Stephens LS, Posner KL, Michna E, Rathmell JP, Pollak KA, et al. Injury and liability associated with implantable devices for chronic pain. Anesthesiology. 2016;124(6):1384–93.

    Article  CAS  PubMed  Google Scholar 

  60. Abrecht CR, Greenberg P, Song E, Urman RD, Rathmell JP. A contemporary medicolegal analysis of implanted devices for chronic pain management. Anesth Analg. 2017;124(4):1304–10.

    Article  PubMed  Google Scholar 

  61. Coffey RJ, Owens ML, Broste SK, Dubois MY, Ferrante FM, Schultz DM, et al. Mortality associated with implantation and management of intrathecal opioid drug infusion systems to treat noncancer pain. Anesthesiology. 2009;111(4):881–91.

    Article  PubMed  Google Scholar 

  62. Scanlon MM, Gazelka HM, Moeschler SM, Hoelzer BC, Hooten WM, Bendel MA, et al. Surgical site infections in cancer patients with intrathecal drug delivery devices. Pain Med. 2017;18(3):520–5.

    PubMed  Google Scholar 

  63. Konrad PE, Huffman JM, Stearns LM, Plunkett RJ, Grigsby EJ, Stromberg EK, et al. Intrathecal drug delivery systems (IDDS): the implantable systems performance registry (ISPR). Neuromodulation. 2016;19(8):848–56.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Eck JC, Nachtigall D, Humphreys SC, Hodges SD. Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature. Spine J. 2008;8(3):488–97.

    Article  PubMed  Google Scholar 

  65. Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology. 2003;226(1):119–24.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA

    Eric J. Wang & Cameron Kluth

  2. Department of Anesthesia and Critical Care Medicine, Johns Hopkins Hospital and Sibley Memorial Hospital, Washington, DC, USA

    Dermot P. Maher

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  1. Eric J. Wang
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Editors and Affiliations

  1. Richard J. Kitz Professor of Anesthesia Research Harvard Medical School, Harvard University, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA

    Jianren Mao

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Wang, E.J., Kluth, C., Maher, D.P. (2020). Complications of Interventional Therapy for the Management of Low Back Pain. In: Mao, J. (eds) Spine Pain Care. Springer, Cham. https://doi.org/10.1007/978-3-030-27447-4_31

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  • DOI: https://doi.org/10.1007/978-3-030-27447-4_31

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