(2013) The risks of epidural and transforaminal steroid injections in the Spine

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642757/

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…

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.

http://abcnews.go.com/Health/epidural-steroid-injection-risk-incurable-arachnoiditis/story?id=17552260

Helen Bertelli, a mother of two young girls from Raleigh, N.C., has been crippled with weird symptoms — electric shocks, muscle cramps and the sensation that water is running down her legs — all since she received an epidural steroid injection for back pain in 2011.

Three months after a medical “fellow” administered the shot at a pain clinic, she had trouble urinating, then both her feet went numb.

“I had this feeling I was connected to the end of a guitar string and someone was plucking it,” said Bertelli, 36, and a former runner and hiker. “My legs just exploded like there were fireworks in them. My muscles twitched like they were boiling.”

For months doctors told her the knife-like pains were in her head, but six months later, Bertelli was diagnosed with arachnoiditis, an incurable condition that can be associated with epidural steroid injections…

http://nationalpainreport.com/fda-warns-about-epidurals-8823722.html

“I am relieved and hopeful that things are on the right track, but there is still much more that needs to be done to stop these ineffective, harmful pain treatments from maiming and crippling people and ruining their lives,” said Dawn Gonzalez, whose spine was permanently damaged by an epidural during child birth. She now suffers from arachnoiditis and is an advocate for Arachnoiditis Society for Awareness and Prevention (ASAP).

“They need to do something to warn specifically about arachnoiditis, and do something to help those of us that have already been damaged by these procedures. They will find that these instances are not in fact rare like they say, but are in epidemic proportions relative to the number of these injections that have been given over the last 10 or so years.” …

http://www.burtonreport.com/infspine/epiduralsteroidshistory.htm

How then historically, given this checkered background, did epidural steroid injections (ESI) become such a widespread non-specific treatment for low back pain? There can be no question but that this “shotgun” therapy is commonly used in the United States, as well as other countries. It’s popularity seems to relate, to a large degree, to be a “knee-jerk” means of providing short-term back pain relief. The only rationale for ESI use is the generalized anti-inflammatory action of steroids and also the observation that many patients with back pain can recover spontaneously if their initial pain is moderated. Statistics demonstrate however that the same result can be achieved with most forms of other non-invasive therapies…

In a 1999 review of 13 studies published on the use of epidural steroids 8 of the reports showed no measurable benefits (Rozenberg S et al: Efficacy of epidural steroids in low back pain and sciatica, Rev. Rhum. Engl. Ed., 66:79-85, 1999 (Feb)). In a review editorial published in the British Medical Journal the authors pointed out that randomized controlled studies and the systematic reviews of randomized trials have not shown convincing evidence that ES injections provide predictable relief for sciatica and/or back pain (Samanta A, SamanthaJ: Is epidural injection of steroids effective for low back pain? BMJ, 328:1509-10, 2004)…

http://www.health.harvard.edu/blog/new-recommendations-aim-to-improve-safety-of-pain-relieving-spinal-steroid-injections-201505077991

Following the recommendations is entirely voluntary, and there are no studies to prove they actually prevent injuries…

https://en.wikipedia.org/wiki/New_England_Compounding_Center_meningitis_outbreak

Doses from these three lots had been distributed to 75 medical facilities in 23 states, and doses had been administered to about 14,000 patients after May 21 and before September 24, 2012. Patients began reporting symptoms in late August, but, because of the unusual nature of the infection, clinicians did not begin to realize the cases had a common cause until late September. Infections other than meningitis were also associated with this outbreak, which spanned 19 states. As of March 10, 2013, 48 people had died and 720 were being treated for persistent fungal infections…

http://www.pharmacist.com/track-and-trace-law-2015-deadlines-new-requirements

January 1 and July 1 are key deadlines in 2015 for new requirements for pharmacists under the Drug Supply Chain Security Act—the track-and-trace part of the compounding and track-and-trace legislation known as the Drug Quality and Security Act and signed into law in 2013…

By January 1, 2015, dispensers (primarily pharmacies) must establish systems for verification and handling of suspect or illegitimate product, according to the FDA website. The agency published a related draft guidance in June 2014…

8 thoughts on “(2013) The risks of epidural and transforaminal steroid injections in the Spine

  1. I had 3 epidurals in my spine. 2 in my neck and one in my lower back. The 2 neck ones didn’t work and the back one made it worse. If I had done my back first I wouldn’t let them touch my neck.

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  2. when i received each of my 3 epidurals using steroids, they told me 2/3 don’t work, but when it does work, it works extremely well, and would likely last for about 10 yrs. well, the first 2 didn’t work, but the 3rd one really did work, almost instantly. and it did work to keep me from being incapacitated by pain for the next 10 yrs, when i started to have similar pain episodes as i had 10 yrs ago, before the injections. i went back to a pain specialist, and this time was recommended facet injections of steroids. i received this 2 separate times, and after the 2nd, i have never had a further episode of pain that kept me from functioning normally. occasionally i have a day or 2 with just enough pain that i take a couple of vicodin and muscle relaxers and then i’m fine.

    so epidural injections do work for some people (aobut a 1/3, i guess) and when they work, they give years of relief. and facet injections work as well, at least often enough that pain docs keep using it just as they keep using epidural steroid injections. if no one was benefiting they would stop using these treatments. and i am one of those people who are glad these options exist, or i would still be in chronic pain from the waist down, with a paralyzed right leg. these shots saved me from a life of chronic pain and loss of the use of my right leg.

    i’m glad i had an open mind on all the treatments available, or i would not have had these shots. and i would not have gotten better.

    Liked by 1 person

    • I guess you were lucky, while so many are not. But if the success of a treatment boils down to luck, one must then ask: How lucky am I? Are the risks worth finding that out?

      It’s funny what some people attribute their pain relief to… Treatments that aren’t proven, like acupuncture or reiki, are great if they help, but very expensive if they don’t. At least with these kinds of treatments, there’s not much risk of doing further damage.

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      • i also had all those treatments done, acupuncture for several months running. i did homeopathy, naturalist treatments, aromatherapy, chiropractry, massage therapy, chelation therapy, herbalism, holistic medicine, and reflexology. none of it helped. the only thing that helped was the epidural and facet injections. and they told me going in that 2/3 people received some moderate to none zero help. and that the other 1/3 would get full relief, and if it did that, it would last about 10 yrs. (which it did) They also told me going in that it was likely that only 1 of the 3 shots would work. it was my 3rd one which did, within 1 day of having it. my leg that had been basically paralyzed, as i could not feel the leg at all from hip down, even started regaining feeling and eventually came back to me with only a little loss of function from the extensive time the nerves were pinched. this was a miracle for me, but not because of my faith, because of medical science. these epidural steroid injections were the only anti-inflammatory strong enough and precisely delivered to the nerve roots to relieve the inflammation from the nerves being pinched long enough to allow the swelling and inflammation to actually go away so that the nerves could recover functioning again without pain.

        this many-year experience left me fully in the camp of medical science, even tho i went in looking for and expecting some kind of CAM to be my answer; but, after all those alternative treatments did nothing, this only served to prove to me that they are not worth the time it takes to say their names. at least science was willing to admit their limitations, the likelihood of success and the common outcomes for most patients. CAM keeps telling you you just need to keep trying, to keep ‘working it’ instead of admitting their actual success rate and common outcomes. which are mostly due to the phenomena of people believing and expecting to see a set result, and convincing themselves that it is there. people who don’t convince themselves of its efficacy, don’t get any results. as they say, it’s
        ‘all in your head’. scientific medical results are not in my head, they are quantifiable, verifiable, and can be reproduced. whether i ‘believe’ in the treatment or not, there is or is not a result, and i know the likelihood of success before starting.

        Liked by 1 person

        • The problem is in what your interventional pain doctor told you about the success rate and how those injections work. Maybe for your particular problem, those statistics may bear out. But most people who have those injections are suffering from chronic back pain without any kind of paralysis, and for those people, these statistics aren’t true. Many go on to have dozens of injections, even more, with only short-term, if any, relief. And the more injections you have, the higher the risk of something going wrong.

          My oral surgeon told me that the TMJ surgery had a 70% success rate. I thought those were pretty good odds, and that statistic was one of the reasons I agreed to the surgery. But it turns out, that was just a made up number. And the doctor’s definition of “success” was not the same as mine. I was looking for pain relief and he was looking to improve the range of motion in my jaw. I could care less about my range of motion — all I cared about was relief. But the surgery made things worse, both the pain levels and my range of motion. For a long time, I just thought I was one of the unlucky 30%, but the truth of the matter was that surgery only has something like a 10% success rate.

          Patients should know the truth about success rates and risks, or else they can’t make informed decisions.

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    • I had 3. 2 in my neck and one in my back. The 2 in the neck gave me a little relief for a few months. the back one made it worse. I was warned it would either work, not work or make things worse before having them. Not I get steroid/lidocaine in my trigger points or directly into the painful area.

      Liked by 1 person

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