Complications of Cervical Epidural Steroid Injections
Epidural Steroid Injections (ESIs) are widely used in the United States to treat chronic and acute pain. The ESI is an injection of a long lasting steroid (“cortisone") in the area which surrounds the spinal cord and the nerves coming out of it, called the epidural space. The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and thesteroidmedication (triamcinolone — Aristocort® or methylprednisolone— Depo-medrol®, Celestone-Soluspan). These injections are routinely performed by anesthesiologists, physical medicine and rehabilitation physicians, neurologists, and radiologists, as well as other specialists. Thesteroidinjected reduces the inflammation and/or swelling of nerves in the epidural space. This may in turn reduce pain, tingling and numbness and other symptoms caused by nerve inflammation/irritation or swelling. It is commonly accepted that these procedures have risks, although the general perception is that their incidence is low.
ESIs have been endorsed by the North American Spine Society and the Agency for Healthcare Research and Quality (formerly, the Agency for Health Care Policy and Research) of the Department of Health and Human Services as an integral part of nonsurgical management of radicular pain from lumbar spine disorders.
Radicular pain is frequently described as a sharp, radiating pain, often shooting from the low back down into the lower limb(s) in a radicular fashion. Radicular pain is the result of a nerve root lesion and/or inflammation. In contrast to oral steroids, ESIs offer the advantage of a more localized medication delivery to the area of affected nerve roots, thereby decreasing the likelihood of potential systemic side effects. Studies have indicated that ESIs are most effective in the presence of acute nerve root inflammation. While this procedure may be effective for you, you should be aware of the possible side effects before choosing to have an ESI.
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain - which is temporary. The other risks involve spinal puncture with headaches, infection, bleeding inside the epidural space with nerve damage, worsening of symptoms, etc. The other risks are related to the side effects of cortisone: weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body’s own natural production of cortisone, etc.
As with all injections, infection is a possible complication of a cervical ESI. Although your doctor will take precautions to maintain a sterile environment, infection is always a risk. A localized skin infection can spread to the epidural space and further spread to the entire spinal column. this can result in severe neurological deficits. In addition, delayed treatment may allow this infection to spread to other parts of your body. Look for excessive pain, redness, warmth or drainage from the injection site if you suspect an infection. Alert your doctor immediately.
Your doctor may inadvertently advance the needle past the epidural space and into the dural space. According to eOrthopod.com , this is called a “wet tap" and in itself is not dangerous. A puncture in the dural space can cause cerebral spinal fluid to leak out and lead to a post-puncture headache. Although painful, your headache should resolve itself in a few days.
Any time a procedure is performed that is in the vicinity of the spinal cord or spinal nerves, nerve damage is a possible side effect. This side effect is rare because the spinal cord is surrounded by many protective tissues and is located deep within the spinal column. You may notice neurological signs, such as shooting pain, if your spinal cord or spinal nerves are touched with an injection needle.
Decreased Bone Density
According to the Mayo Clinic, decreased bone density is a possible side effect of cervical epidural steroid injections. Epidural steroid injections contain corticosteroids, which are hormones naturally produced by your body. However, injected steroids into your epidural space will exceed the level naturally available in your body. This high level of localized steroids can effect the bone-manufacturing process of your bone cells. Therefore, if you have osteoporosis or another bone disease, a steroid injection may increase your fracture risk.
Malpractice and Other Steroid Side Effects
Overall, cervical injections are associated with low complication rates, but possible serious side effects could include spinal-cord infarction, epidural hematoma and respiratory arrest. Medical malpractice can occur in a number of ways including physician inattention, inaccurate dosage levels, positioning of the patient, use of fluoroscopy, needle size, the presence or absence of patient complaints or movement. Make sure that you thoroughly research your physician, and to make sure he/she has many years of experience performing this procedure. Try to speak to former or current patients of the doctor, his/her current staff members, and your primary care physician for their recommendation.
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