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Objective: To report on the incidence of dysphonia and/or associated throat symptoms after steroid injections in the axial skeleton., Design: A prospective cohort study., Setting: Academic spine center., Participants: Patients (N = 100) undergoing a diagnostic injection followed by a therapeutic injection in the axial skeleton., Interventions: Not applicable., Main Outcome Measure: Presence or absence of dysphonia and/or associated throat symptoms, as determined by completion of a predetermined 10-item questionnaire. This questionnaire was administered before participation in the study and at specific intervals after a diagnostic injection and, again, after a therapeutic spinal injection., Results: There was a 12% incidence of transient dysphonia and/or associated throat symptoms in this study population after a therapeutic injection., Conclusions: Throat symptoms are a potential, albeit transient side effect, after an epidural space corticosteroid injection. The mechanism through which dysphonia or other throat symptoms develop is unknown but appears to be mediated by a systemic steroid effect.

Objective: To determine the incidence of complications and side effects of cervical and lumbosacral selective nerve root injections (SNRIs)., Design: Prospective, nonrandomized controlled trial of consecutive patients with independent interviews for immediate, 1-week, and 3-month follow-ups., Setting: Tertiary, academic spine center., Participants: Of 160 patients eligible for SNRI, 151 underwent 306 SNRIs (study group). Sixty patients who had not undergone any intervention served as the control group., Interventions: Diagnostic and therapeutic fluoroscopically guided cervical and lumbosacral SNRIs. Lidocaine (Xylocaine) was used in the diagnostic injections and a mixture of lidocaine and betamethasone was used in the therapeutic injections., Main Outcome Measures: Complications and side effects experienced during the procedure were recorded by the interventionalist. Side effects and complications experienced immediately, 1 week, and 3 months after injection were determined through independent interviews using a questionnaire format. The control group was independently interviewed using the same questionnaire., Results: There were no major complications, such as death, paralysis, spinal nerve injury, infection, or allergic reaction, during the study. Ninety-one percent of subjects had no side effects during the procedure. A positive response on interview was reported by 39.4% of the study subjects immediately after the procedure. Lumbosacral SNRI side effects were as follows: increased pain at the injection site (17.1%); increased radicular pain (8.8%); lightheadedness (6.5%); increased spine pain (5.1%); nausea (3.7%); nonspecific headache (1.4%); and vomiting (0.5%). Immediate side effects from cervical SNRI were as follows: increased pain at injection site (22.7%); increased radicular pain (18.2%); lightheadedness (13.6%); increased spine pain (9.1%); nonspecific headache (4.5%); and nausea (3.4%). At the 1-week interview, comparison of the study and control groups showed statistical significance for the following: pain at injection site, cervical ( P =.001) and lumbar ( P =.005); nonspecific headache, cervical ( P =.019); and nonspinal headache, cervical ( P =.002). At 3 months, 2 subjects complained of increased neck pain and 1 reported heartburn and fluid retention. Two lumbar SNRI subjects were lost to follow-up., Conclusions: There were no major complications with cervical and lumbosacral SNRIs, although various minor side effects occurred.

A 46-year-old patient with left-side low back pain developed symptoms of dysphonia and throat irritation 24 hours after receiving a fluoroscopically guided steroid injection into the epidural space. A direct laryngoscopy performed before a second injection detected no abnormalities. When dysphonia reappeared 48 hours after that injection, laryngoscopy revealed edema in the anterior vocal cord with thick surrounding mucous. Full clinical resolution of the dysphonia was apparent by laryngoscopy 15 days after the second injection. The mechanism of dysphonia after epidural steroid injection is unknown, but it may result from a systemic steroid effect.

Objective: To report our experience using fluoroscopically guided therapeutic intra-articular C2-3 zygapophyseal joint injections in patients with chronic headaches after a whiplash event., Design: Restrospective study (n = 18 patients) with independent clinical review. Each patient experienced persistent daily headache symptoms which failed to improve after at least 3 mo of physical therapy, activity restriction, and the use of oral analgesics. Each patient demonstrated initially a positive response to a diagnostic intra-articular C2-3 joint injection. Data collection and analysis were performed by an independent clinical reviewer. Outcome measures included headache frequency, medication usage, symptom response to medication, and employment status., Results: Patients' symptom duration before diagnostic injection averaged 34 mo. Follow-up data collection transpired at an average of 19 mo after the final therapeutic injection. In 61% of patients, fewer than three headaches were experienced each week; these headaches were relieved with the use of oral analgesics., Conclusions: Although the inherent limitations of this study preclude a definitive statement regarding the efficacy of C2-3 injections, these initial findings suggest that therapeutic intra-articular zygapophyseal joint injections are effective in the treatment of headaches emanating from the C2-3 joint after a whiplash event. Future controlled, prospective studies are necessary to clarify the role of such injections in this challenging patient population.