Advertisement

Complications of Interventional Therapy for the Management of Low Back Pain

  • Eric J. Wang
  • Cameron Kluth
  • Dermot P. Maher
Chapter

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.

Keywords

Low back pain Local anesthetic systemic toxicity (LAST) Contrast agent allergy Corticosteroids Particulate steroids Non-particulate steroids Epidural steroid injections (ESI) Facet nerve blocks Medial branch blocks Radiofrequency ablation (RFA) Sacroiliac joint injections (SIJ) Intradiscal procedures Intrathecal drug delivery systems (IDDS) Vertebroplasty and kyphoplasty 

References

  1. 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.PubMedGoogle Scholar
  2. 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.Google Scholar
  3. 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.PubMedGoogle Scholar
  4. 4.
    Bogduk N. Practice guidelines for spinal diagnostic procedures. San Francisco: International Spine Intervention Society; 2013.Google Scholar
  5. 5.
    Carr CM, Plastaras CT, Pingree 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.PubMedGoogle Scholar
  6. 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.PubMedGoogle Scholar
  7. 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.PubMedGoogle Scholar
  8. 8.
    Rathmell JP. Atlas of image-guided intervention in regional anesthesia and pain medicine. 2nd ed. Philidelphia: Lippincott Williams & Wilkins; 2011.Google Scholar
  9. 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.Google Scholar
  10. 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.Google Scholar
  11. 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.PubMedGoogle Scholar
  12. 12.
    Kay J, Findling JW, Raff H. Epidural triamcinolone suppresses the pituitary-adrenal axis in human subjects. Anesth Analg. 1994;79(3):501–5.PubMedGoogle Scholar
  13. 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.Google Scholar
  14. 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.PubMedGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. 16.
    Lento P, Ihm J, Kennedy DJ, Visco CJ. Peripheral joint and soft tissue injection techniques. 4th ed. Philadelphia: Elsevier; 2011.Google Scholar
  17. 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.PubMedGoogle Scholar
  18. 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.PubMedGoogle Scholar
  19. 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.PubMedGoogle Scholar
  20. 20.
    Hooten WM, Kinney MO, Huntoon MA. Epidural abscess and meningitis after epidural corticosteroid injection. Mayo Clin Proc. 2004;79(5):682–6.PubMedGoogle Scholar
  21. 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.Google Scholar
  22. 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.PubMedGoogle Scholar
  23. 23.
    Houten JK, Errico TJ. Paraplegia after lumbosacral nerve root block: report of three cases. Spine J. 2002;2(1):70–5.PubMedGoogle Scholar
  24. 24.
    Benzon HT, Huntoon MA, Rathmell JP. Improving the safety of epidural steroid injections. JAMA. 2015;313(17):1713–4.PubMedGoogle Scholar
  25. 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.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Landers MH. Spinal cord injury during attempted cervical interlaminar epidural injection of steroids. Pain Med. 2018;19(4):652–7.PubMedGoogle Scholar
  27. 27.
    Friedly J, Chan L, Deyo R. Increases in lumbosacral injections in the Medicare population: 1994 to 2001. Spine. 2007;32(16):1754–60.PubMedGoogle Scholar
  28. 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.PubMedPubMedCentralGoogle Scholar
  29. 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.PubMedGoogle Scholar
  30. 30.
    Cohen SP, Huang JH, Brummett C. Facet joint pain--advances in patient selection and treatment. Nat Rev Rheumatol. 2013;9(2):101–16.PubMedPubMedCentralGoogle Scholar
  31. 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.PubMedGoogle Scholar
  32. 32.
    Smith M, Ferretti G, Mortazavi S. Radiographic changes induced after cervical facet radiofrequency denervation. Spine J. 2005;5(6):668–71.PubMedGoogle Scholar
  33. 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.PubMedGoogle Scholar
  34. 34.
    Weingarten TN, Hooten WM, Huntoon MA. Septic facet joint arthritis after a corticosteroid facet injection. Pain Med. 2006;7(1):52–6.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Kornick C, Kramarich SS, Lamer TJ, Todd SB. Complications of lumbar facet radiofrequency denervation. Spine. 2004;29(12):1352–4.PubMedGoogle Scholar
  36. 36.
    Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106(3):591–614.Google Scholar
  37. 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.PubMedGoogle Scholar
  38. 38.
    Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005;101(5):1440–53.Google Scholar
  39. 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.PubMedPubMedCentralGoogle Scholar
  40. 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.PubMedGoogle Scholar
  41. 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.PubMedPubMedCentralGoogle Scholar
  42. 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.PubMedGoogle Scholar
  43. 43.
    Carragee EJ, Alamin TF. Discography: a review. Spine J. 2001;1(5):364–72.PubMedGoogle Scholar
  44. 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.PubMedGoogle Scholar
  45. 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.PubMedGoogle Scholar
  46. 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.PubMedGoogle Scholar
  47. 47.
    Darmoul M, Bouhaouala MH, Rezgui M. Calcification following intradiscal injection, a continuing problem? Presse Med. 2005;34(12):859–60.PubMedGoogle Scholar
  48. 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.PubMedGoogle Scholar
  49. 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.PubMedGoogle Scholar
  50. 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.PubMedGoogle Scholar
  51. 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.PubMedGoogle Scholar
  52. 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.PubMedGoogle Scholar
  53. 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.PubMedPubMedCentralGoogle Scholar
  54. 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.PubMedPubMedCentralGoogle Scholar
  55. 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.PubMedPubMedCentralGoogle Scholar
  56. 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.Google Scholar
  57. 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.PubMedGoogle Scholar
  58. 58.
    Silber JS, Anderson DG, Vaccaro AR, Anderson PA, McCormick P. Management of postprocedural discitis. Spine J. 2002;2(4):279–87.PubMedGoogle Scholar
  59. 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.PubMedGoogle Scholar
  60. 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.PubMedGoogle Scholar
  61. 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.PubMedGoogle Scholar
  62. 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.PubMedGoogle Scholar
  63. 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.PubMedPubMedCentralGoogle Scholar
  64. 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.PubMedGoogle Scholar
  65. 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.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Eric J. Wang
    • 1
  • Cameron Kluth
    • 1
  • Dermot P. Maher
    • 2
  1. 1.Department of Anesthesiology and Critical Care MedicineJohns Hopkins HospitalBaltimoreUSA
  2. 2.Department of Anesthesia and Critical Care MedicineJohns Hopkins Hospital and Sibley Memorial HospitalWashington, DCUSA

Personalised recommendations