Complications After Lumbar Spine Epidural Steroid Injections: Incidence and Risk Factors

Study Design Retrospective Study. Objectives Lumbar epidural steroid injections (LESIs) are frequently used to manage symptoms and pain stemming from degenerative conditions of the lumbar spine. This study aimed to determine the incidence and risk factors of complications after LESI. Method The Merative MarketScan Commercial and Medical Supplemental databases were queried for LESIs in 18+ patients. LESIs were distinguished based on the approach: interlaminar or transforaminal. Complications were categorized into overall, procedural, and medical. Generalized estimating equations logistic regression with repeated measures, clustered by patient identifier, were used to identify factors associated with complications at 7 and 30 days after the LESI. Results The study cohort consisted of 362,976 patients who underwent a total of 722,366 LESIs from 2014 to 2021. Complication rates after LESIs were 2.5% within 7 days and 8.8% within 30 days. 45.0% of LESIs utilized the interlaminar approach, while the transforaminal approach was used in 54.0% of LESIs. The patient factors independently associated with the greatest odds of complications included older age 85+ vs 18-34, 7 day OR: 1.32 (1.20, 1.45); P < 0.001, heart failure 7 day OR: 1.95 (1.84, 2.06); P < 0.001, renal dysfunction 7 day OR: 1.51 (1.41, 1.63); P < 0.001, neurological deficits 7 day OR: 1.37 (1.31, 1.44); P < 0.001, and anticoagulant prescriptions 7 day OR: 3.28 (3.10, 3.48); P < 0.001. Conclusions LESIs were associated with a rare but non-negligible risk of complications, which continued to occur until 30-days post injection. Several patient factors were associated with the risk of post-procedure complications.