• Koen Van Boxem, Mienke Rijsdijk, Guy Hans, Jasper de Jong, Jan Willem Kallewaard, Kris Vissers, van Kleef Maarten M Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands., James P Rathmell, and Jan Van Zundert.
• Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium.
• Pain Pract. 2019 Jan 1; 19 (1): 61-92.

BackgroundEpidural corticosteroid injections are used frequently worldwide in the treatment of radicular pain. Concerns have arisen involving rare major neurologic injuries after this treatment. Recommendations to prevent these complications have been published, but local implementation is not always feasible due to local circumstances, necessitating local recommendations based on literature review.MethodsA work group of 4 stakeholder pain societies in Belgium, The Netherlands, and Luxembourg (Benelux) has reviewed the literature involving neurological complications after epidural corticosteroid injections and possible safety measures to prevent these major neurologic injuries.ResultsTwenty-six considerations and recommendations were selected by the work group. These involve the use of imaging, injection equipment particulate and nonparticulate corticosteroids, epidural approach, and maximal volume to be injected.ConclusionRaising awareness about possible neurological complications and adoption of safety measures recommended by the work group aim at reducing the risks for these devastating events.© 2018 The Authors. Pain Practice published by Wiley Periodicals, Inc. on behalf of World Institute of Pain.

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