Epidural steroid injection explained

Epidural steroid injection
Specialty:Pain Medicine

Epidural steroid injection (ESI) is a technique in which corticosteroids and a local anesthetic are injected into the epidural space around the spinal cord in an effort to improve spinal stenosis, spinal disc herniation, or both. It is of benefit with a rare rate of major side effects.

Medical uses

Epidural steroid injection for sciatica and spinal stenosis is of unclear effect.[1] The evidence to support use in the cervical spine is not very good.[2] When medical imaging is not used to determine the proper spot for injection, ESI benefits appear to be of short-term benefit when used in sciatica.[3] It is unclear if ESI is useful for chronic pain after spinal surgery.[4]

Side effects

Major side effects are rare. These include loss of vision, stroke, paralysis, or death when the corticosteroids are infected, as in a 2012 meningitis outbreak.[5] [6] Another study found an increased odds of developing epidural lipomatosis, independent of body mass index (BMI) or other factors.[7]

Technique

Elective spinal injections should be performed with imaging guidance, such as fluoroscopy or the use of a radiocontrast agent, unless that guidance is contraindicated. Imaging guidance ensures the correct placement of the needle and maximizes the physician's ability to make an accurate diagnosis and administer effective therapy. Without imaging, the risk increases for the injection to be incorrectly placed, and this would in turn lower the therapy's efficacy and increase subsequent risk of need for more treatment.

Notes and References

  1. Shaughnessy . AF . Epidural Steroid Not Better Than Placebo Injection for Sciatica and Spinal Stenosis Pain and Function. . American Family Physician . 15 February 2016 . 93 . 4 . 315–6 . 26926820 .
  2. Cohen . SP . Hooten . WM . Advances in the diagnosis and management of neck pain . BMJ (Clinical Research Ed.) . 14 August 2017 . 358 . j3221 . 28807894 . 10.1136/bmj.j3221 . 29500924 .
  3. Vorobeychik . Y . Sharma . A . Smith . CC . Miller . DC . Stojanovic . MP . Lobel . SM . Valley . MA . Duszynski . B . Kennedy . DJ. Standards Division of the Spine Intervention. Society . The Effectiveness and Risks of Non-Image-Guided Lumbar Interlaminar Epidural Steroid Injections: A Systematic Review with Comprehensive Analysis of the Published Data. . Pain Medicine (Malden, Mass.) . December 2016 . 17 . 12 . 2185–2202 . 10.1093/pm/pnw091 . 28025354 . free .
  4. Wylde . V . Dennis . J . Beswick . AD . Bruce . J . Eccleston . C . Howells . N . Peters . TJ . Gooberman-Hill . R . Systematic review of management of chronic pain after surgery. . The British Journal of Surgery . September 2017 . 104 . 10 . 1293–1306 . 10.1002/bjs.10601 . 28681962 . 5599964.
  5. Schneider . B . Zheng . P . Mattie . R . Kennedy . DJ . Safety of epidural steroid injections. . Expert Opinion on Drug Safety . August 2016 . 15 . 8 . 1031–9 . 10.1080/14740338.2016.1184246 . 27148630 . 27053083 .
  6. Kauffman . CA . Malani . AN . 42550449 . Fungal Infections Associated with Contaminated Steroid Injections . Microbiology Spectrum . April 2016 . 4 . 2 . 359–374 . 10.1128/microbiolspec.EI10-0005-2015 . 27227303 . 978-1-55581-944-6 .
  7. Jaimes . Rafael . Rocco . Angelo . Multiple epidural steroid injections and body mass index linked with occurrence of epidural lipomatosis: a case series . BMC Anesthesiology . August 2014 . 14 . 70 . 70 . 10.1186/1471-2253-14-70 . 25183952 . 4145583 . free .

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