Complications of Spinal Diagnostic and Treatment Procedures


  • Prepared on behalf of the International Spine Intervention Society and the American Academy of Pain Medicine

Nikolai Bogduk, MD, PhD, DSc, Newcastle Bone and Joint Institute, Royal Newcastle Centre, Newcastle NSW 2300, Australia. Tel: 61-2-49223505; Fax: 61-2-49223559; E-mail:


Background.  Spinal intervention procedures are widely practiced. Complications are sometimes described in case reports, but the full spectrum of possible complications has not been comprehensively publicized. The fact that certain complications continue to occur suggests that practitioners may not be fully aware of the nature of possible complications and how to recognize warning signs.

Objectives.  To highlight the nature of potential complications of spine interventions and to assist practitioners in recognizing warning signs of impending complications so that they might be prevented.

Methods.  Complications described in the literature and encountered by the authors in medicolegal proceedings were identified. Illustrations of such complications were collated together with illustrations of phenomena that might have led to complications had they not been recognized and the procedure appropriately corrected or abandoned.

Results.  Infection is a risk common to all invasive procedures. Spinal cord injuries have occurred during cervical medial branch blocks, intra-articular injections, and radiofrequency neurotomy because operators did not obtain correct views of the target region and misdirected their needles or electrodes. Similar errors have occurred in the conduct of lumbar blocks and neurotomy. The complications of lumbar intradiscal procedures include infection, injury to a ventral ramus, and breakage of electrodes. Cervical discography, additionally, can be complicated by spinal cord injury. Cervical transforaminal injections have been complicated by injections into a reinforcing radicular artery or the vertebral artery. Lumbar transforaminal injections have been complicated by intra-arterial injections and subdural or intrathecal injections. Epidural injections can be complicated by subdural or intrathecal injections, or venous puncture resulting in a haematoma. Intra-articular injections of the lateral atlantoaxial joint and sacroiliac joint theoretically could be complicated by injury to adjacent vessels, nerves, or viscera.

Discussion.  Strict adherence to published guidelines provides safeguards against encountering complications. Complications are avoided by operators knowing all the relevant anatomy of the procedure and being able to recognize aberrations in the procedure as soon as they occur.