Risk of Steroid Epidural Injections

[Violet M]

Surg Neurol Int. 2013 Mar 22;4(Suppl 2):S74-93. doi: 10.4103/2152-7806.109446. Print 2013.
The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature.
Epstein NE.

The Albert Einstein College of Medicine, Bronx, 10461, and Chief of Neurosurgical Spine and Education, Department of Neuroscience, Winthrop University Hospital, Mineola, NY, 11501, USA.

Abstract
BACKGROUND:
Multiple type of spinal injections, whether epidural/translaminar or transforaminal, facet injections, are offered to patients with/without surgical spinal lesions by pain management specialists (radiologists, physiatrists, and anesthesiologists). Although not approved by the Food and Drug Administration (FDA), injections are being performed with an increased frequency (160%), are typically short-acting and ineffective over the longer-term, while exposing patients to major risks/complications.
METHODS:
For many patients with spinal pain alone and no surgical lesions, the "success" of epidural injections may simply reflect the self-limited course of the disease. Alternatively, although those with surgical pathology may experience transient or no pain relief, undergoing these injections (typically administered in a series of three) unnecessarily exposes them to the inherent risks, while also delaying surgery and potentially exposing them to more severe/permanent neurological deficits.
RESULTS:
Multiple recent reports cite contaminated epidural steroid injections resulting in meningitis, stroke, paralysis, and death. The Center for Disease Control (CDC) specifically identified 25 deaths (many due to Aspergillosis), 337 patients sickened, and 14,000 exposed to contaminated steroids. Nevertheless, many other patients develop other complications that go unreported/underreported: Other life-threatening infections, spinal fluid leaks (0.4-6%), positional headaches (28%), adhesive arachnoiditis (6-16%), hydrocephalus, air embolism, urinary retention, allergic reactions, intravascular injections (7.9-11.6%), stroke, blindness, neurological deficits/paralysis, hematomas, seizures, and death.
CONCLUSIONS:
Although the benefits for epidural steroid injections may include transient pain relief for those with/without surgical disease, the multitude of risks attributed to these injections outweighs the benefits.

[river133]

Oh my gosh,this is really scary, I had an epideral
injection about 3 weeks ago, and also in the past 4 years. among the 3 I had from Dr.Antalok, 2 different pain clinics, Include another
4 from them. Interesting because our Grandson was here a while ago ,He is in a nursing program at St. Johns U. He said Grandma,what ever you do,do not have any more steroid injections. I have one injection that helped for a fwo months for sciatic problems but never pudendal problems. That was last Granted only one of these was in the form of an epideral.. I have chronic sciatic pain. My spine Dr.said I do not have , significant stenosis and didn't think he could help me with surgery. Said it would be 50/50. He wants to see me again on the 8th which is next week.because the epidural did not have good results.: I need to call his office and try to see what his plan is. Probably more epiderals. He already said,as I said no surgery.My sciatic pain just continues to worsen.Of course the neighbor to sciatic,Ms.pudendal is showing little if any improvement.
Does any one know what nerves cause drop foot. ? Woe are we.

[nyt]

Very interesting abstract. There are risks with everything. Considering the large number of epidural steriod injections that are done every year I am surprised by how high these statistics are. I'll have to read the original paper to see how the study was done.

river133, foot drop is caused by damage to the peroneal nerve which is a branch off of the sciatic nerve. Makes sense in your case that you have problems with your sciatic nerve that you have foot drop.

[acw]

Oh my gosh,this is really scary, I had an epideral
injection about 3 weeks ago, and also in the past 4 years. among the 3 I had from Dr.Antalok, 2 different pain clinics, Include another
4 from them.

Since when is Dr Antolak doing epidural injections? That would make me a little nervous, having a urologist messing around with my back.

[river133]

My mistake,Dr.Antalok did not give me an epideral. The only epideral I had was about a month ago with CDI. I was just thinking of all of the steroid injections I have had the past 5 years. This foot drop thing is really scaring me. My foot gives me no problems at this point. I have good movement and I walk daily...so far so good,but it is a concern .I will be seeing a neurologist in few days. I am anxious to know the EMG results,and also a NVI. Not sure I am correct about the latter test. I will have to go back and check Dr. Chambi's request.

[Violet M]

Nyt, if you have access to the full article I would be interested to hear more about what you think. I don't have the full article. At the very least, patients should have a complete warning regarding all of the risks before they agree to an epidural.

Violet

[Karyn]

From Dr. Oz:

http://www.youtube.com/watch?v=QCbzXqrG0ic

[deBBieW]

really frightening. I would never thought to even ask if the medication is FDA approved. It's so common, I would have just assumed.

I'm going to look up my pudendal block report and see what they used to inject me.

Thanks Karen.

[Karyn]

Hi Deb!
I think the cocktails they use for the blocks are a bit different. For instance, my blocks consisted of: bupivacaine, triamicinolone, heparin and ketorolac.
But I agree ... very disturbing investigative report.
Hugs,
Karyn

[chal4oye]

This foot drop thing is really scaring me. My foot gives me no problems at this point. I have good movement and I walk daily...so far so good,but it is a concern .I will be seeing a neurologist in few days. I am anxious to know the EMG results,and also a NVI. Not sure I am correct about the latter test. I will have to go back and check Dr. Chambi's request.