• Jeremy I Simon, Jeffrey Gehret, Eric S Larsen, Kyle S Hummerston, Philip J Koehler Iii, and Paul M Kitei.
• Department of Physical Medicine and Rehabilitation, Rothman Institute, Philadelphia, PA.
• Pain Physician. 2021 Sep 1; 24 (6): E821-E828.

BackgroundThe American Society of Regional Anesthesia currently recommends ceasing antithrombotic medications for all spinal epidural steroid injections, however there is a paucity of data on the true risk of spinal epidurals via various approaches versus the risk of cessation of an agent as it relates to the underlying medical condition.ObjectiveThis study evaluated the complication rate of caudal epidural steroid injections in patients who remain on antithrombotic medications.Study DesignRetrospective chart review.SettingPhysiatric Spine Clinic in Orthopedic Specialty Office and Surgical Center.MethodsA retrospective chart review was performed identifying patients (n = 335) who received a caudal epidural steroid injection (n = 673) from June 2015 through April 2020. Patients were included if they had received the injection while taking an antithrombotic medication. Patients were excluded if they were not taking an antithrombotic. The patient's age, indication for the injection including magnetic resonance imaging or computed tomography findings, antithrombotic medication, the medical condition requiring an antithrombotic, and any complications following the injection were collected via chart review.ResultsOf the 443 injections included in the study, 51 encounters were lost to follow-up. Of the other 392 injections, there were no reported complications, regardless of the patient's imaging findings, age, the antithrombotic medication used, or the underlying medical condition for which an antithrombotic medication was indicated.LimitationsThis is a retrospective study. Therefore, a prospective study may have yielded fewer encounters lost to follow-up. Patients were not contacted directly after the procedure and chart reviews were utilized to evaluate for complications, which was limited to a patient's reporting of perceived complications without any imaging.ConclusionsWe conclude that caudal epidural steroid injections can be performed safely in patients while taking antithrombotic medications. Catastrophic events have been observed in patients who have discontinued antithrombotic agents preceding procedures. Thus, discontinuing antithrombotic medications may pose a greater risk than benefit for patients on an antithrombotic medication who have painful lumbar radiculopathy.

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