Epidural Steroid Injections And Compression Fractures

Epidural Steroid Injections And Compression Fractures

Epidural Steroid Injections And Compression Fractures

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Epidural Steroid Injections have been used to treat patients with both herniated disks as well as for patients with spinal stenosis.  In addition,  the same steroid compounds have been used by physicians to treat arthritic conditions of the spine, via the so called facet joint injection.

Most prudent practitioners have always cautioned the patients that there are still associated risks with any invasive treatments,  and that includes these spinal injections.

In 2012,  our nation unfortunately witnessed one of the potential complications with administration of these injections.  The FDA,  CDC, and the new media was busy tracking the unfortunate development of infections cause by contamination of the injected compound steroid.  Many patients suffered significant infections, causing serious medical conditions including death.  On  a daily basis,  my patients still ask if I used the cortisone from the specific compounding pharmacies.  I assured them that I used a different brand, and there had not been any association with my brand of choice to the contaminated vials of cortisone.

Still, as per protocol,  patients that undergo these injections are told of the risks including, but not limited to infection,  nerve irritation,  blood sugar elevation,  water retention, effects from steroid use, etc.

With patients that have a history of osteoporosis, or risk factors for osteoporosis,  I often have the discussion that these injections have potential to make there bones weaker.  Well now,  unfortunately,  we have information that does suggest there should be a concern for use of the epidural steroid injections  secondary to osteoporosis and development of compression fractures.

In the Journal of Bone and Joint Surgery,  June 5, 2013 issue,  Dr. Mandel performed a retrospective review on patients that received epidural steroid injections.  Then,  he found a matching group of patients with all the same medical conditions, and complaints, except they did not have the epidural steroid injection.  Dr. Mandel found that each successive injection increased the risk of compression fracture by a factor of 1.21  after adjusting for covariates.

Certainly,  this is a retrospective review, and not a blinded control study,  but the conclusion suggests exposure to steroids from epidural steroid injections may carry a greater risk of fragility fractures than once thought.

The take home message is that physicians and patients should approach this option with more caution.

 

 

 

 

 

 

Citations

  • Hong JH, Lee YH. Comparison of incidence of intravascular injections during transforaminal epidural steroid injection using different needle types. Korean J Anesthesiol. 2014 Sep;67(3):193-7. PubMed PMID: 25302096

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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