Steroid Spinal Injections
A recent article in the Sunday Mail reported on the rare and severe complications relating to steroid nerve root injections and epidurals. The link for this story is found below:
Steroid injections have been used for years by radiologist and pain specialist to treat chronic back and neck pain. However, we have also known for years about the detrimental side effects and complications that can occur when using steroids for these procedures. A quick search of the medical literature shows numerous case reports and scientific studies showing the occurrence of "spinal and nerve strokes", leaving patients with permanent neurological deficits such as paraplegia, as was reported in the Sunday Mail article. Whilst a rare complication, it does occur. The medical literature also shows that the use of steroid injections for chronic neck and back pain has, at best, a limited and short term response. Some studies even suggest that the use of steroids in multiple spinal procedures over time can actually make a patients condition worse! The other important point to consider is that despite the widespread use of CT guided steroid nerve root injections, few medical studies have examined the safety of this approach!
I have struggled with the use of steroid nerve root and epidural injections over the years because the procedure is not treating the underlying problem causing the pain. Interventional Regenerative Orthopaedics is an exciting, new medical field, which is using safe and effective treatments to deal with the underlying cause of a patients pain rather than mask it with a short term, potentially dangerous solution such as steroids. Using regenerative medicine treatments is a real alternative which is now available in my clinic OrthoRegen Australia. Advances in Platelet-Rich Plasma injections and Ozone injections are showing better long term outcomes than steroid injections for epidurals and nerve root injections. Even Prolotherapy, the use of a dextrose solution to treat joint instability and ligamentous structures around the spine has shown better long term efficacy in the medical literature. Dextrose epidurals are also showing excellent results for the treatment of chronic lumbar back pain and several studies have shown the long term and neurogenic effects of dextrose and its ability to heal nerves over time.
The take home message....Do your research if a doctor refers you to a radiologist or pain specialist for steroid injections to your spine. Make sure the physician performing the procedure is using dexamethasone (a steroid that is non-particulate, meaning it has less risk of causing severe complications than Celestone), contrast to view the appropriate region of the injection, making sure the needle is not entering a blood vessel and that careful needle placement under CT guidance is achieved dorsal to the nerve root being injected. The alternative - seek out regenerative medicine treatments to treat the underlying cause rather than use a "band-aid" procedure that will worsen your pain over time and potentially cause a detrimental complication.