Background: The pathogenic mechanisms involved in a disastrous scenario, following
epidural steroid injections (ESI), remain unclarified. Intra-arterial injection of steroids with needlepenetrating
vascular injury would be the culprit, as particulate medicine elicits a brain or spinal
cord stroke-like attack.
Methods: On the other hand, the limited experimental approaches simulating an accidental steroid
intra-arterial injection for ESI conflicted in their results: hemorrhage vs. ischemia.
Results: This article dissects the potential pathogenic mechanisms at a neurovascular unit. Noticeably,
a schematic representation provides an explanation of how emboli formed by particulate
steroids elicit either hemorrhagic, or ischemic lesion.
Conclusion: In addition, the development of a rat model with intravertebral artery steroid injection
is a proposal to address the unmet need in evaluating steroids and vascular injury in ESI.