sibneiroСибнейроSibneuro3033-649X3033-6805Bervitskiy Anatoliy Vladimirovich10.64265/3033-649X-2026.2.3.51-61sibneiro-126Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHОценка частоты и структуры осложнений при проведении эпидуральных поясничных инъекций в практике амбулаторного центра лечения болиAssessment of the frequency and structure of complications during lumbar epidural injections in the practice of an outpatient pain management centerhttps://orcid.org/0000-0003-3244-4688СпиридоновА. В.SpiridonovA. V.

Спиридонов Алексей Викторович – кандидат медицинских наук, врач-нейрохирург, ЛДЦ ФармСибКо; Краевая клиническая больница.

ул. Никитина, 1В, стр. 1, Красноярск, 660022; ул. Партизана Железняка, 3А, Красноярск, 660022

Alexey V. Spiridonov – Cand. Sci. (Med.), Neurosurgeon, PharmSibKo Medical and Diagnostic Center; Regional Clinical Hospital.

Nikitina str., 1V, building 1, Krasnoyarsk, 660022; Partizana Zhelesnyaka str., 3A, Krasnoyarsk, 660022

maleta2008@mail.ruhttps://orcid.org/0009-0006-6464-4077СаленкоА. А.SalenkoA. A.

Саленко Алексей Александрович – врач-нейрохирург, ЛДЦ ФармСибКо; Краевая клиническая больница.

ул. Никитина, 1В, стр. 1, Красноярск, 660022; ул. Партизана Железняка, 3А, Красноярск, 660022

Alexey A. Salenko – Neurosurgeon, PharmSibKo Medical and Diagnostic Center; Regional Clinical Hospital.

Nikitina str., 1V, building 1, Krasnoyarsk, 660022; Partizana Zhelesnyaka str., 3A, Krasnoyarsk, 660022

salenkolexa@mail.ruhttps://orcid.org/0000-0001-7498-5998АртюховаЕ. В.ArtyukhovaE. V.

Артюхова Елена Васильевна – врач-невролог.

ул. Никитина, 1В, стр. 1, Красноярск, 660022

Elena V. Artyukhova – neurologist, PharmSibKo Medical and Diagnostic Center.

Nikitina str., 1V, building 1, Krasnoyarsk, 660022

art.lena@mail.ruhttps://orcid.org/0000-0001-5389-929XБорисовВ. Э.BorisovV. E.

Борисов Владислав Эдуардович – кандидат медицинских наук, доцент кафедры госпитальной хирургии, БГУ им. Доржи Банзарова; врач-нейрохирург, Республиканская клиническая больница им. Н.А. Семашко.

ул. Смолина, 24А, Улан-Удэ, 670000; ул. Павлова, 12, Улан-Удэ, 670031

Vladislav E. Borisov – Cand. Sci. (Med.), Associate Professor at the Department of Advanced-Level Surgery, Buryat State University; Neurosurgeon, N.A. Semashko Republican Clinical Hospital.

Smolina str., 24A, Ulan-Ude, 670000; Pavlova str., 12, Ulan-Ude, 670031

nevrotom@mail.ruЛечебно-диагностический центр ФармСибКо; Краевая клиническая больницаРоссияPharmSibKo Medical and Diagnostic Center; Regional Clinical HospitalRussian FederationЛечебно-диагностический центр ФармСибКоРоссияPharmSibKo Medical and Diagnostic CenterRussian FederationБурятский государственный университет имени Доржи Банзарова; Республиканская клиническая больница им. Н.А. СемашкоРоссияBuryat State University; N.A. Semashko Republican Clinical HospitalRussian Federation202616102026235161Copyright © Спиридонов А.В., Саленко А.А., Артюхова Е.В., Борисов В.Э., 20262026Спиридонов А.В., Саленко А.А., Артюхова Е.В., Борисов В.Э.Spiridonov A.V., Salenko A.A., Artyukhova E.V., Borisov V.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibneurojournal.com/jour/article/view/126Введение

Введение. Эпидуральные поясничные инъекции широко применяются при хронической боли в пояснице и корешковом синдроме.

Цель исследования

Цель исследования. Оценить частоту и структуру транзиторных реакций, системных побочных реакций на лекарственную терапию и процедурных осложнений при проведении эпидуральных поясничных инъекций в практике амбулаторного центра лечения боли.

Материалы и методы

Материалы и методы. В период с января 2016 г. по январь 2026 г. проведено одноцентровое ретроспективное наблюдательное исследование. Исследуемая группа включала пациентов, которым выполнялись интерламинарные и трансфораминальные поясничные эпидуральные инъекции под рентгеноскопическим контролем. В анализ включено 3 757 процедур.

Результаты

Результаты. Зарегистрировано 85 событий (2,26 % от числа процедур): 5 процедурных осложнений (0,133 %), включая 3 случая постпункционной головной боли и 2 случая пневмоцефалии; 39 транзиторных реакций, связанных с процедурой (1,04 %); 41 системная побочная реакция на лекарственную терапию (1,09 %). Большинство событий носили кратковременный и обратимый характер. Два случая пневмоцефалии после интерламинарного доступа потребовали госпитализации и завершились полным регрессом клинической симптоматики.

Заключение

Заключение. Эпидуральные поясничные инъекции при соблюдении рентгеноскопического контроля и стандартов безопасности характеризуются низкой частотой клинически значимых процедурных осложнений. Раздельный учет трех категорий событий позволяет более корректно оценивать профиль безопасности вмешательства.

Introduction

Introduction. Lumbar epidural injections are widely used for chronic low back pain and radicular pain.

The aim

The aim. To assess the frequency and structure of transient procedure-related reactions, systemic adverse drug reactions, and procedure-related complications associated with lumbar epidural injections in an outpatient pain management center.

Materials and methods

Materials and methods. A single-center retrospective observational study was conducted from January 2016 to January 2026. The study group included patients who underwent fluoroscopy-guided interlaminar and transforaminal lumbar epidural injections. A total of 3,757 procedures were analyzed.

Results

Results. Eighty-five events were recorded (2.26 % of all procedures): 5 procedure-related complications (0.133 %), including 3 cases of post-dural puncture headache and 2 cases of pneumocephalus; 39 transient procedure-related reactions (1.04 %); and 41 systemic adverse drug reactions (1.09 %). Most events were transient and reversible. Two cases of pneumocephalus after interlaminar injections required hospitalization and resolved completely.

Conclusion

Conclusion. Lumbar epidural injections performed under fluoroscopic guidance and in accordance with safety standards are associated with a low rate of clinically significant procedure-related complications. Separate reporting of the three event categories provides a more accurate assessment of procedural safety.

эпидуральные инъекциипоясничный отдел позвоночниканежелательные явленияосложнениялечение болибезопасностьдексаметазонретроспективное исследованиеepidural injectionslumbar spineadverse eventscomplicationspain managementsafetydexamethasoneretrospective studyReferencesSoin A, Gupta M, Abd-Elsayed AA, Nashi S. Lumbar epidural steroid injections for chronic spinal pain: A clinical review of efficacy and evidence. Cureus. 2025; 17(12): e98348. https://doi.org/10.7759/cureus.98348Soin A, Gupta M, Abd-Elsayed AA, Nashi S. Lumbar epidural steroid injections for chronic spinal pain: A clinical review of efficacy and evidence. Cureus. 2025; 17(12): e98348. https://doi.org/10.7759/cureus.98348Benoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: An update of their efficacy and safety. Eur Spine J. 2012; 21(2): 204-213. https://doi.org/10.1007/s00586-011-2007-zBenoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: An update of their efficacy and safety. Eur Spine J. 2012; 21(2): 204-213. https://doi.org/10.1007/s00586-011-2007-zBartleson JD, Maus TP. Diagnostic and therapeutic spinal interventions: Epidural injections. Neurol Clin Pract. 2014; 4(4): 347-352. https://doi.org/10.1212/CPJ.0000000000000043Bartleson JD, Maus TP. Diagnostic and therapeutic spinal interventions: Epidural injections. Neurol Clin Pract. 2014; 4(4): 347-352. https://doi.org/10.1212/CPJ.0000000000000043Epstein NE, Agulnick MA. Perspective: Risks/adverse events for epidural spinal injections. Surg Neurol Int. 2024; 15: 392. https://doi.org/10.25401/sni-2024.15.392Epstein NE, Agulnick MA. Perspective: Risks/adverse events for epidural spinal injections. Surg Neurol Int. 2024; 15: 392. https://doi.org/10.25401/sni-2024.15.392Каратеев АЕ. Эпидуральные блокады с использованием глюкокортикоидов: как насчет принципов доказательной медицины? Современная ревматология. 2016; 10(3): 87-94. https://doi.org/10.14412/1996-7012-2016-3-87-94Karateev AE. Epidural blockades using glucocorticoids: As to how the principles of evidence-based medicine? Modern Rheumatology Journal. 2016; 10(3): 87-94. (In Russ.). https://doi.org/10.14412/1996-7012-2016-3-87-94Борисов ВЭ, Хитрихеев ВЕ, Степанов ИА, Цыбиков БЗ, Артюхова ЕВ, Борисова ИИ. Оценка эффективности трансламинарных эпидуральных инъекций при лечении болей на фоне дегенеративных заболеваний поясничного отдела позвоночника. Инновационная медицина Кубани. 2023; (1): 103-110. https://doi.org/10.35401/2541-9897-2023-26-1-103-110Borisov VE, Khitrikheev VE, Stepanov IA, Tsybikov BZ, Artyukhova EV, Borisova II. Evaluating the efficacy of translaminar epidural injections for pain resulting from the lumbar spine degenerative disease. Innovative Medicine of Kuban. 2023; (1): 103-110. (In Russ.). https://doi.org/10.35401/2541-9897-2023-26-1-103-110Christie J. FDA issues drug safety communication about epidural corticosteroid injections. APSF Newsletter. 2015; 30(3). URL: https://www.apsf.org/article/fda-issues-drug-safety-communication-about-epidural-corticosteroid-injections/ (Accessed: 21.09.2026).Christie J. FDA issues drug safety communication about epidural corticosteroid injections. APSF Newsletter. 2015; 30(3). URL: https://www.apsf.org/article/fda-issues-drug-safety-communication-about-epidural-corticosteroid-injections/ (Accessed: 21.09.2026).Firth S. FDA advisers tackle epidural steroid shots. MedPage Today. 2014 Nov 24. URL: https://www.medpagetoday.com/primarycare/backpain/48797 (Accessed: 21.09.2026).Firth S. FDA advisers tackle epidural steroid shots. MedPage Today. 2014 Nov 24. URL: https://www.medpagetoday.com/primarycare/backpain/48797 (Accessed: 21.09.2026).Valdivia LM, Jain M, Mucollari O, Jain C, Stern BZ, Chaudhary SB. Complications after lumbar spine epidural steroid injections: Incidence and risk factors. Global Spine J. 2026 Jan 20. https://doi.org/10.1177/21925682261417984Valdivia LM, Jain M, Mucollari O, Jain C, Stern BZ, Chaudhary SB. Complications after lumbar spine epidural steroid injections: Incidence and risk factors. Global Spine J. 2026 Jan 20. https://doi.org/10.1177/21925682261417984McGrath JM, Schaefer MP, Malkamaki DM. Incidence and characteristics of complications from epidural steroid injections. Pain Med. 2011; 12(5): 727-733. https://doi.org/10.1111/j.1526-4637.2011.01088.xMcGrath JM, Schaefer MP, Malkamaki DM. Incidence and characteristics of complications from epidural steroid injections. Pain Med. 2011; 12(5): 727-733. https://doi.org/10.1111/j.1526-4637.2011.01088.xKaraman H, Kavak GO, Tüfek A, Yıldırım ZB. The complications of transforaminal lumbar epidural steroid injections. Spine (Phila Pa 1976). 2011; 36(13): E819-E824. https://doi.org/10.1097/BRS.0b013e3181f32baeKaraman H, Kavak GO, Tüfek A, Yıldırım ZB. The complications of transforaminal lumbar epidural steroid injections. Spine (Phila Pa 1976). 2011; 36(13): E819-E824. https://doi.org/10.1097/BRS.0b013e3181f32baeLee JW, Lee E, Lee GY, Kang Y, Ahn JM, Kang HS. Epidural steroid injection-related events requiring hospitalisation or emergency room visits among 52,935 procedures performed at a single centre. Eur Radiol. 2018; 28(1): 418-427. https://doi.org/10.1007/s00330-017-4977-7Lee JW, Lee E, Lee GY, Kang Y, Ahn JM, Kang HS. Epidural steroid injection-related events requiring hospitalisation or emergency room visits among 52,935 procedures performed at a single centre. Eur Radiol. 2018; 28(1): 418-427. https://doi.org/10.1007/s00330-017-4977-7El-Yahchouchi CA, Plastaras CT, Maus TP, Carr CM, McCormick ZL, Geske JR, et al. Adverse event rates associated with transforaminal and interlaminar epidural steroid injections: A multi-institutional study. Pain Med. 2016; 17(2): 239-249. https://doi.org/10.1111/pme.12896El-Yahchouchi CA, Plastaras CT, Maus TP, Carr CM, McCormick ZL, Geske JR, et al. Adverse event rates associated with transforaminal and interlaminar epidural steroid injections: A multi-institutional study. Pain Med. 2016; 17(2): 239-249. https://doi.org/10.1111/pme.12896Осипов СА, Овечкин АМ. Безопасность спинальной и эпидуральной анестезии с точки зрения оценки риска неврологических осложнений. Регионарная анестезия и лечение боли. Тематический сборник. Москва, Тверь; 2004: 81-92.Osipov SA, Ovechkin AM. Safety of spinal and epidural anesthesia regarding the risk of neurological complications. Regional Anesthesia and Pain Management. Thematic Collection. Moscow, Tver; 2004: 81-92. (In Russ.).Шифман ЕМ. 30 вопросов по эпидуральной анестезии. Школа регионарной анестезии. URL: https://www.critical.ru/actual/2/a2_a.html (Accessed: 21.09.2026).Shifman EM. 30 questions on epidural anesthesia. School of Regional Anesthesia. (In Russ.). URL: https://www.critical.ru/actual/2/a2_a.html (Accessed: 21.09.2026).Фишер Б. Как избежать неврологических осложнений? Рекомендации ESRA для надлежащей клинической практики. Регионарная анестезия и лечение острой боли. 2010; 4(2): 54-59. https://doi.org/10.17816/RA36092Fischer B. How to avoid neurological damage? ESRA recommendations for good clinical practice. Regional Anesthesia and Acute Pain Management. 2010; 4(2): 54-59. (In Russ.). https://doi.org/10.17816/RA36092Половинкина ВВ, Узбекова ЛД. Анатомические особенности осложнений после эпидуральной анестезии. Аллея науки. 2019; 11(38): 44-48.Polovinkina VV, Uzbekova LD. Anatomical features of complications following epidural anesthesia. Alleya Nauki. 2019; 11(38): 44-48. (In Russ.).Sencan S, Sacaklidir R, Gunduz OH. The immediate adverse events of lumbar interventional pain procedures in 4,209 patients: An observational clinical study. Pain Med. 2022; 23(1): 76-80. https://doi.org/10.1093/pm/pnab230Sencan S, Sacaklidir R, Gunduz OH. The immediate adverse events of lumbar interventional pain procedures in 4,209 patients: An observational clinical study. Pain Med. 2022; 23(1): 76-80. https://doi.org/10.1093/pm/pnab230Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Freeman TL, Slaten WK. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil. 2000; 81(8): 1045-1050. https://doi.org/10.1053/apmr.2000.7166Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Freeman TL, Slaten WK. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil. 2000; 81(8): 1045-1050. https://doi.org/10.1053/apmr.2000.7166Manchikanti L, Malla Y, Wargo BW, Cash KA, Pampati V, Fellows B. A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections. Pain Physician. 2012; 15(2): 131-140.Manchikanti L, Malla Y, Wargo BW, Cash KA, Pampati V, Fellows B. A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections. Pain Physician. 2012; 15(2): 131-140.Chang A, Ng AT. Complications associated with lumbar transforaminal epidural steroid injections. Curr Pain Headache Rep. 2020; 24(11): 67. https://doi.org/10.1007/s11916-020-00900-9Chang A, Ng AT. Complications associated with lumbar transforaminal epidural steroid injections. Curr Pain Headache Rep. 2020; 24(11): 67. https://doi.org/10.1007/s11916-020-00900-9Eworuke E, Crisafi L, Liao J, Akhtar S, Van Clief M, Racoosin JA, et al. Risk of serious spinal adverse events associated with epidural corticosteroid injections in the Medicare population. Reg Anesth Pain Med. 2021; 46(3): 203-209. https://doi.org/10.1136/rapm-2020-101778Eworuke E, Crisafi L, Liao J, Akhtar S, Van Clief M, Racoosin JA, et al. Risk of serious spinal adverse events associated with epidural corticosteroid injections in the Medicare population. Reg Anesth Pain Med. 2021; 46(3): 203-209. https://doi.org/10.1136/rapm-2020-101778Smith GA, Pace J, Strohl M, Kaul A, Hayek S, Miller JP. Rare neurosurgical complications of epidural injections: An 8-yr single-institution experience. Oper Neurosurg. 2017; 13(2): 271-279. https://doi.org/10.1093/ons/opw014Smith GA, Pace J, Strohl M, Kaul A, Hayek S, Miller JP. Rare neurosurgical complications of epidural injections: An 8-yr single-institution experience. Oper Neurosurg. 2017; 13(2): 271-279. https://doi.org/10.1093/ons/opw014Lee CS, Park YJ, Moon JY, Kim YC. Deep spinal infection after outpatient epidural injections for pain: A retrospective sample cohort study using a claims database in South Korea. Anesthesiology. 2021; 134(6): 925-936. https://doi.org/10.1097/ALN.0000000000003770Lee CS, Park YJ, Moon JY, Kim YC. Deep spinal infection after outpatient epidural injections for pain: A retrospective sample cohort study using a claims database in South Korea. Anesthesiology. 2021; 134(6): 925-936. https://doi.org/10.1097/ALN.0000000000003770Lee MS, Moon HS. Safety of epidural steroids: A review. Anesth Pain Med. 2021; 16(1): 15-27. https://doi.org/10.17085/apm.20087Lee MS, Moon HS. Safety of epidural steroids: A review. Anesth Pain Med. 2021; 16(1): 15-27. https://doi.org/10.17085/apm.20087Rosati R, Schneider BJ. Systemic effects of steroids following epidural steroid injections. Curr Phys Med Rehabil Rep. 2019; 7: 397-403. https://doi.org/10.1007/s40141-019-00245-4Rosati R, Schneider BJ. Systemic effects of steroids following epidural steroid injections. Curr Phys Med Rehabil Rep. 2019; 7: 397-403. https://doi.org/10.1007/s40141-019-00245-4Kopp SL, Vandermeulen E, McBane RD, Perlas A, Leffert L, Horlocker T. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fifth edition). Reg Anesth Pain Med. 2025 Oct 17: rapm-2024-105766. https://doi.org/10.1136/rapm-2024-105766Kopp SL, Vandermeulen E, McBane RD, Perlas A, Leffert L, Horlocker T. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fifth edition). Reg Anesth Pain Med. 2025 Oct 17: rapm-2024-105766. https://doi.org/10.1136/rapm-2024-105766Klessinger S, Schuster NM, Waring PH, Vorobeychik Y, Schneider BJ, Johnson SC, et al.; International Pain and Spine Intervention Society. Safety practices for interventional pain procedures: Epidural and sacroiliac interventions. Interv Pain Med. 2025; 4(2): 100579. https://doi.org/10.1016/j.inpm.2025.100579Klessinger S, Schuster NM, Waring PH, Vorobeychik Y, Schneider BJ, Johnson SC, et al.; International Pain and Spine Intervention Society. Safety practices for interventional pain procedures: Epidural and sacroiliac interventions. Interv Pain Med. 2025; 4(2): 100579. https://doi.org/10.1016/j.inpm.2025.100579Duszynski B. Spine Intervention Society position statement on best practices for epidural steroid injections in the setting of a preservative-free dexamethasone shortage. Pain Med. 2019; 20(7): 1277-1280. https://doi.org/10.1093/pm/pnz063Duszynski B. Spine Intervention Society position statement on best practices for epidural steroid injections in the setting of a preservative-free dexamethasone shortage. Pain Med. 2019; 20(7): 1277-1280. https://doi.org/10.1093/pm/pnz063Verheijen EJA, Bonke CA, Amorij EMJ, Vleggeert-Lankamp CLA. Epidural steroid compared to placebo injection in sciatica: A systematic review and meta-analysis. Eur Spine J. 2021; 30(11): 3255-3264. https://doi.org/10.1007/s00586-021-06854-9Verheijen EJA, Bonke CA, Amorij EMJ, Vleggeert-Lankamp CLA. Epidural steroid compared to placebo injection in sciatica: A systematic review and meta-analysis. Eur Spine J. 2021; 30(11): 3255-3264. https://doi.org/10.1007/s00586-021-06854-9Verdun AV, Cohen SP, Williams BS, Hurley RW. Pneumocephalus after lumbar epidural steroid injection: A case report and review of the literature. A A Case Rep. 2014; 3(1): 9-13. https://doi.org/10.1213/XAA.0000000000000055Verdun AV, Cohen SP, Williams BS, Hurley RW. Pneumocephalus after lumbar epidural steroid injection: A case report and review of the literature. A A Case Rep. 2014; 3(1): 9-13. https://doi.org/10.1213/XAA.0000000000000055Jagia M, Kapoor MC, Panjiar P. Pneumocephalus after epidural analgesia: Should loss of resistance with air be blown out? J Anaesthesiol Clin Pharmacol. 2016; 32(2): 272-273. https://doi.org/10.4103/0970-9185.173399Jagia M, Kapoor MC, Panjiar P. Pneumocephalus after epidural analgesia: Should loss of resistance with air be blown out? J Anaesthesiol Clin Pharmacol. 2016; 32(2): 272-273. https://doi.org/10.4103/0970-9185.173399Sharma K, Devgan S. Pneumocephalus after lumbar epidural. Med J Armed Forces India. 2019; 75(1): 117-119.Sharma K, Devgan S. Pneumocephalus after lumbar epidural. Med J Armed Forces India. 2019; 75(1): 117-119.Reddi S, Honchar V, Robbins MS. Pneumocephalus associated with epidural and spinal anesthesia for labor. Neurol Clin Pract. 2015; 5(4): 376-378.Reddi S, Honchar V, Robbins MS. Pneumocephalus associated with epidural and spinal anesthesia for labor. Neurol Clin Pract. 2015; 5(4): 376-378.

The authors declare that there are no conflicts of interest present.