Chills Up the Spine with Steroid Shot

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Spinal fracture risks up with epidural steroid injection for back pain

June 12, 2013 / Author:  / Reviewed by: Joseph V. Madia, MD

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(dailyRx News) Lower back pain is a common and frustrating symptom that happens in most adults. A steroid shot to reduce swelling and pain can help. That shot, however, is not without risk.

Certain steroid injections into the spine for pain were linked with an increased risk of getting a spinal fracture, a new study shows.

According to researchers, the findings suggest that steroid injections in the lower part of the spine could lead to increased bone fragility.

The authors suggested that patients at risk for fractures associated with osteoporosis be given special attention when considering this treatment.

"Check out the risks with epidural steroid injections."

Shlomo Mandel, MD, MPH, from the Department of Orthopaedic Surgery at Henry Ford West Bloomfield Hospital, and colleagues led a study investigating whether steroid injections into the spine affect the risk of spinal fractures.

These steroid injections, called lumbar epidural steroid injections (LESI) are commonly used to help with sciatica (pain and weakness along the sciatic nerve running down the leg) and spinal stenosis (narrowing of the spinal column).

The researchers identified more than 50,000 patients in a corporate database who were diagnosed with a spinal condition. Among those patients, 3,415 had had at least one steroid injection.

From the group who had the injections, 3,000 were randomly selected to participate in the study. Another 3,000 patients who did not have any steroid injections were also randomly selected from the database to compare results.

The patients were about 66 years old on average. Those who were under 50 years of age, had a tumor on the spine or had a fracture in the vertebrae from other spinal procedures were excluded from the study.

The researchers tracked the number of fractures each patient had along their spine.

As the number of spinal injections increased, the likelihood of getting a fracture also increased, the researchers found.

Each injection upped the chance of fracture by 21 percent after adjusting for gender, race, age and steroid use.

"Although therapeutic steroids often reduce the pain associated with lumbar radiculopathy, skeletal quality could be compromised, particularly after frequent and prolonged treatment," the researchers wrote in their report.

The epidural injections might help individuals with their spinal conditions, but according to the researchers, most of the patients were elderly and already at an increased risk for fragile bones.

The researchers noted that they did not take smoking history, exercise amount or body size into account when performing their research.

The study, funded by the Nancy James Grosfield Foundation, was published online June 5 in the Journal of Bone & Joint Surgery.

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Review Date: 
June 12, 2013
Last Updated:
August 7, 2013