Complications during lumbar selective nerve root block: a scoping review.

INTRODUCTION: Selective Nerve Root Block (SNRB) is widely used for managing radicular pain, serving both therapeutic and diagnostic purposes. A complete list of all reported complications associated with SNRB has never been reported. AIM: To map the existing evidence on complications associated with lumbar SNRB. METHODS: A scoping review was conducted of peer-reviewed studies on complications associated with transforaminal or foraminal lumbar SNRB in adults with degenerative spine conditions. A systematic search was performed across six databases on 9th of September 2024. Two independent reviewers screened studies for eligibility. RESULTS: Of the 6,939 screened studies, 118 met the inclusion criteria, comprising a total of 15,817 patients and 72,518 SNRB procedures. A total of 145 distinct complication types and 4,439 complications were identified. Of these, 5.2% were classified as mild/moderate and 0.2% as severe according to the CTCAE grading system. The rate of complications for each study varied substantially, ranging from 0.2% to 73% calculated per procedure. Across all studies, the overall adjusted complication rate was 5.4% per procedure and 5.8% per patient. The most frequent were intravascular injection, vasovagal reactions, and central steroid effect. Severe events, including infection and paralysis, were rare (≤ 0.03%). DISCUSSION AND CONCLUSION: The SNRB procedure has a low complication rate, with serious complications being rare. This scoping review highlights the heterogeneous complication data in publications. Standardized guidelines for SNRB complication reporting are warranted.