Serious complications including damage to the neural elements, stroke and death have been reported with epidural corticosteroid injections (ESIs) but are mostly anecdotal. Their true incidence is unknown, but such outcomes seem to be rare.

Vascular penetration is possible, relatively more frequent in the cervical segments and potentially hazardous. Intravascular injection can be reduced by use of injected contrast media.

The use of a blunt needle, live fluoroscopy, digital subtraction angiography and the administration of a small test dose initially could help reduce the adverse effects.

Many complications can be avoided by a thorough understanding of the anatomy, accurate placement of the needle and familiarisation of the contrast patterns on fluoroscopy.

More research must be performed regarding the benefits versus risk, techniques and outcome of ESIs.