Epidural Steroid Injections And Compression Fractures
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.
- 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