Key safety considerations when administering epidural steroid injections

Pain Manag. 2015;5(4):261-72. doi: 10.2217/pmt.15.17. Epub 2015 Jun 10.


Neurological and other complications of epidural steroid injections have been widely discussed in recent years. Consequently, the US FDA issued a warning about serious neurological events, some resulting in death, and consequently is requiring label changes. Neurological adverse events numbering 131, including 41 cases of arachnoiditis, have been identified by the FDA, and 700 cases of fungal meningitis following injection of contaminated steroids. A review of the literature reveals an overwhelming proportion of the complications are related to transforaminal epidural injections, with the majority of them to cervical transforaminal epidural injections. This perspective describes the prevalence of administering epidural injections, complications, pathoanatomy, mechanism of injury and various preventive strategies.

Keywords: arachnoiditis; epidural injections; epidural steroids; intra-arterial injection; local anesthetic; neurological complications; nonparticulate steroids; particulate steroids; steroid toxicity.

Publication types

  • Review

MeSH terms

  • Chronic Pain / drug therapy*
  • Drug Contamination
  • Early Diagnosis
  • Humans
  • Injections, Epidural / adverse effects
  • Mycoses / etiology
  • Nervous System Diseases / etiology
  • Nervous System Diseases / prevention & control
  • Patient Safety
  • Spinal Diseases / etiology
  • Spinal Diseases / prevention & control
  • Steroids / administration & dosage*
  • Steroids / adverse effects*
  • Treatment Outcome


  • Steroids