Flushing and Interlaminar Lumbar Epidural Steroid Injections

Richard M. Vaglienti, MD

Assistant Professor,
Department of Neurosurgery
West Virginia University
Morgantown, WV

Epidural steroid injections are commonly used to treat chronic spinal pain, including axial and radicular pain. Although the specific analgesic mode of action of epidural injections is not well understood, proposed mechanisms include membrane stabilization, inhibition of nociceptive C fiber transmission, and the anti-inflammatory effects of corticosteroids. Despite efficacy in a subpopulation of carefully selected patients, epidural injections may cause serious complications, including spinal cord or epidural hematoma, spinal cord trauma, vascular injury, pulmonary embolism, and death. Most complications, however, are minor and nonspecific; flushing, for instance, is thought to be mediated by immunoglobulin (IgE) and histamine. While various steroid preparations have been used, dexamethasone is becoming increasingly popular; its nonparticulate properties convey significantly less risk of embolic infarcts, even after accidental intra-arterial injection. Here, Dr. Vaglienti discusses a recent study on flushing associated with lumbar epidural dexamethasone injections for low back pain with radicular symptoms.

References

1. Kim CH, Issa MA, Vaglienti RM. Flushing following interlaminar lumbar epidural steroid injection with dexamethasone. Pain Physician. 2010;13:481-484.
2. Everett CR, Baskin MN, Speech D, Novoseletsky D, Patel R. Flushing as a side effect following lumbar transforaminal epidural steroid injection. Pain Physician. 2004;7:427-429.
3. Botwin KP, Gruber RD, Bouchlas CG, et al. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil. 2000;81:1045-1050.

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