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The Dark Side of Epidural Steroid Injection - Potential Risks and Complications From the Procedure and Long-Term Side Effects

Published on Aug 12, 2022 and last reviewed on Jan 24, 2023   -  5 min read

Abstract

Epidural steroid injections relieve painful conditions related to the spine, though the treatment has some potential risks and complications associated with it.

Introduction:

Epidural steroid injections have been in use for a long time for treating spine-related pains. With extensive studies conducted on them, a lot of patients have benefitted from epidural steroid injections for their pain relief. It has helped many to avoid surgeries as well. Many professional athletes have gotten back into their careers with successful epidural steroid injections instead of surgery. They are often done in a series, which indicates a group of injections at regular intervals. One may need repeated injections every few months. But widespread use of epidural steroid injections has had its side effects. Though people claim it is a low-risk procedure, it is definitely not a zero-risk one.

What Happens in an Epidural Steroid Injection?

The brain and spinal cord are covered and protected by meninges which essentially have three layers. The outermost layer is called the dura. In an epidural injection, Corticosteroid medication is injected into the space beneath the dura. The doctor targets the space between two spinal bones to deposit the medicine. In most individuals, the pain is probably arising from inflammation of the nerve due to various causes. And steroid medications are marked for their anti-inflammatory properties. Hence, the epidural steroid injection gives immediate pain relief for spine-related pains.

Doctors may suggest an infection to relieve the inflammation in the following conditions:

  1. Spinal stenosis (narrowing of the spinal canal for various reasons).

  2. Intervertebral disc bulges.

  3. Bone spurs (bony spikes pushing onto the spinal cord).

  4. Painful spinal cysts and tumors.

  5. Arthritis of the spine.

  6. Spinal injuries from trauma.

  7. Dislocated spine.

  8. Sciatica pain (pain on the buttocks and legs due to nerve injury).

  9. Pain from radiculopathy (as a nerve gets pinched at its root in the spinal cord).

What Are the Potential Risks and Complications Associated With Epidural Steroid Injections?

Following are the possible risks one may encounter from an epidural steroid injection:

  • The Risk of Infection - At the site of injection, one has a risk of developing an infection. The area of injection where the needle goes in is thoroughly sterilized and made free of any bacteria. And one is usually put on antibiotics before the procedure. Even then, there is a certain risk of infection. Especially if there is an existing skin condition at the site of infection, chances are it may get passed on to the spine and reach the brain. The bones and flesh in the area may also form an abscess with pus collection.

  • The Risk of Bleeding - One may start to bleed from the area where the needle goes in the layers covering the spinal cord. Blood may ooze into the space between these layers too. If there is bleeding around the area of injection, a blood clot (hematoma) may be formed. It will compress or push onto the spinal cord and other nerves in the area and cause some problems. A clot may block further blood flow into the spinal cord too. If one is on an anti-clotting medication like Coumadin or Lovenox, it is important to notify the doctor. One needs to stop the drug a few days before the injection. And those taking Aspirin or anti-inflammatory drugs have to stop it too. Hence, it is important to talk to the doctor and find out what should be the exact time frame to stay away from such drugs. Usually, it is five to seven days.

  • Dural Puncture - Sometimes the needle may puncture the dura. Usually, it seals up in an hour or two, and the patient does not feel any symptoms. But if it does not, one may get a spinal headache, as the cerebrospinal fluid (a clear fluid that fills up the space between the meningeal layers and nourishes the brain and spinal cord) may leak out through this puncture site. It is not a major problem as the fluid gets replenished every six hours. If there are severe headaches while standing up and they get better on lying down, it is indicative of spinal headaches. One should notify the doctor and receive the appropriate treatment. If it persists, the doctor may have to do an epidural blood patch. Drinking caffeine may also help with spinal headaches.

  • Nerve Damage - This is exceptionally unusual. But there are instances where people got paralyzed from an epidural steroid injection. Injecting the medicine right into the spinal cord damages it permanently. Sometimes the pain doctor may inadvertently touch the nerve root while trying to put the steroid medication around, and typically the patient may feel it. If this happens, one is supposed to pull the needle back a little and inject the medicine. One may get abnormal sensations, seizures, or loss of sensations too. The irritation may persist for a few days but goes away soon.

  • Cauda Equina Syndrome - This is a rare complication from epidural steroid injection due to nerve damage. One may lose bowel or bladder function after an epidural steroid injection. It is a very rare condition, but it is important to report it to the doctor then and there, as leaving it unattended may lead to lower body paralysis.

  • Pain From Injection and Allergies - It is a local pain where the needle goes through the skin as the numbing medicine wears off. One may continue feeling the pain for a while. There may be numbness and swelling over the area as well, but this is temporary. One may use cold compression to reduce the pain and swelling. Rarely may one suffer from low blood pressure and a low heart rate at the time of the procedure. The local anesthetic agent used at the time of injection may turn toxic to the body. And there is always a risk of allergic reactions to the medicine, which may even turn fatal.

What Are the Possible Side Effects One May Suffer From Repeated Doses of Epidural Spinal Injections?

For conditions like sciatica or radiculopathy that happen from inflammation, the steroid is a huge help. It literally bathes the nerve root with its anti-inflammatory effects and knocks the pain out. But treatment with steroids comes with a few side effects like:

  1. A temporary increase in blood sugar levels.

  2. Sleeplessness and fatigue.

  3. Headache and dizziness.

  4. Facial flushing and anxiety

  5. If one tends to develop ulcers, the steroid may trigger the development of stomach ulcers.

  6. Any type of steroid medication has a tendency to cause weight gain. One may get fat deposits around the face, shoulders, tummy, and back.

Conclusion:

Though epidural steroid injections are a huge relief for long-lasting nerve pain, too much of it will cause more harm than good. Some have noticed that the effectiveness of the procedure diminishes over repeated uses. For conditions like spinal stenosis and others, surgical correction of the underlying cause is the gold standard of treatment. Also, the steroid injection cannot cure the root cause; it can only alleviate the pain and inflammation. Do make it a point to get the procedure done at a reputed health care facility under the care of experts.

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Last reviewed at:
24 Jan 2023  -  5 min read

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