SPINE INJECTION-CORTICOSTEROIDS

SUMMARY

1. A single epidural steroid injection (ESI) can cause adrenal suppression and hypothalamic-pituitary-adrenal axis imbalances for 1-5 weeks; complete suppression is limited to 4-7 days.136

2. An ESI precipitates more prolonged suppression than intra-articular injection.209

3. Many physicians advise no more than 3 ESIs per year or a 6-mth limit of 5 mg/kg of body weight.182

4. After an ESI, diabetics can have elevated BSL during the first 4-7 days post-injection; poorer the diabetic control, the worse the hyperglycaemia; risk of ketoacidosis if severe.

5. Any local infection at the site of proposed injection is a contraindication, even when glucocorticoids are not being administered.

6. Other effects: HTN, risk of new infections, reactivation of latent herpes, potentiate the risk of GIT bleeding, especially with NSAIDs.

7. Accidental IA injection of particulates can lead to spinal cord infarction; cervical transforaminal epidural approach with particulate corticosteroid has been associated with serious complications.

Reference(s)

Furman, Michael B., and Leland Berkwits. Atlas of Image-Guided Spinal Procedures. Elsevier, Inc, 2017.
Horowitz AL. MRI Physics for Physicians. Springer Science & Business Media. (1989) ISBN:1468403338.
Mangrum W, Christianson K, Duncan S et-al. Duke Review of MRI Principles. Mosby. (2012) ISBN:1455700843.