I perform 20-40 transforaminal (TFESI) and/or interlaminar epidural steroid injections (ILESI) every week as a part of my interventional pain medicine practice. The risks associated with both TFESI and ILESI are extremely similar, as both involve needle entry into the epidural space, albeit from different anatomical approaches using different techniques. Procedural risks include, but are not limited to, post-dural puncture headache (PDPH) potentially related to a CSF leak, direct neurological trauma, vascular injection, seizure, permanent nerve injury, worsened pain, no benefit, and infection. All of these should be discussed with the patient, and included on an appropriate informed consent form. It is not uncommon for the interventionalist to change the procedure while the patient is on the fluoroscopic table if fluoro images indicate that the planned approach (TFESI vs ILESI) may be too difficult or not as beneficial, although this must either be consented for in advance, or discussed directly with the patient at that time before proceeding. The described injuries reported in this case involve known potential risks (e.g. PDPH, headache) but also muscle atrophy which, if objectively seen in exam, would presumably indicate severe peripheral or central neurological injury and are obviously not expected outcomes from properly performed TFESI or ILESI.
