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Incidence of Various Types of Systemic Reactions related to Spinal Steroid Injection: A Prospective Study 2013

Category Interventional Guen Young Lee
Joon Woo Lee
Jin S. Yeom
Ki-Jeong Kim
Hyung-Ik Shin
Heung Sik Kang
Purpose Systemic reactions after spinal steroid injection has been reported in previous literatures, in which could not demonstrate their various types and incidence associated with patients’ demographics, underlying disease, and factors of injection. This study was aimed to evaluate the incidence and types of systemic reactions after spinal steroid injections and to investigate the association of spinal steroid injection with patient demographics, history of previous injections, type and dose of steroid, and method and site of previous and current injections. Materials & Methods This prospective study was approved by the institutional review board of our hospital, and written informed consent was obtained from all the participants. This study included 960 spinal steroid injection sessions conducted in 885 patients. Thirty-two patients did not meet the inclusion criteria, and finally, 853 patients were investigated. All systemic and local reactions were examined after 2 weeks by a phone interview, and evaluated according to the patients’ demographics, including age, gender, history of diabetes mellitus or hypertension; anticoagulant medication; history of previous spinal steroid injection; factors of previous and current injections; type and dose of steroid; and presence of repeated injection sessions. Statistical analysis was performed using the chi-square test and binary logistic regression analysis. Results Overall, 557 episodes of systemic reactions after spinal steroid injection were reported (557/960), of which facial flushing was the most common in both single (131/960) and repeated injection sessions (26/148), regardless of patients’ age. Mixed systemic reactions (more than 1 type) were frequent (144/292), especially in cases of repeated injection sessions (odds ratio (OR) = 3.109, p = .001). Systemic reactions were more common in patients ≤ 62 years and in women (p = .000). Of 73 patients with repeated injection sessions, systemic reactions recurred in 14, of which 12 were of the same type. Increased blood glucose level was the most frequent symptom in diabetic patients (OR = 108.524, p = .000), especially with triamcinolone 40 mg (OR = 32.775, p = .000). Cardiovascular disorders were the second most common systemic reaction in hypertensive patients (OR = 3.253, p = .051). Using binary logistic regression, age ≤ 62 years, female sex, and history of diabetes mellitus were found to be significant risk factors for the occurrence of spinal steroid injection-related systemic reactions (p = .000–.020). Conclusion Many systemic reactions occur commonly after spinal steroid injections, especially in patients ≤ 62 years and in women, and may be associated with underlying disease, such as hypertension and diabetes mellitus, as well as steroid dose and repetition of spinal steroid injection within 2 months. References
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Mentored Award Mentored Award Question 1 I have no question about my study. Question 2 I have no question about my study.