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Systemic Effects of Steroids Following Epidural Steroid Injections

  • Published:2019-11-27 Issue:4 Volume:7 Page:397-403
  • ISSN:2167-4833
  • Container-title:Current Physical Medicine and Rehabilitation Reports
  • language:en
  • Short-container-title:Curr Phys Med Rehabil Rep

Author:

Rosati Renee,Schneider Byron J.

Publisher

Springer Science and Business Media LLC

Subject

Rehabilitation,Physical Therapy, Sports Therapy and Rehabilitation,Orthopedics and Sports Medicine,Medicine (miscellaneous)

Reference63 articles.

1. •• El-Yahchouchi CA, Plastaras CT, Maus TP, Carr CM, McCormick ZL, Geske JR, et al. Adverse event rates associated with transforaminal and interlaminar epidural steroid injections: a multi-institutional study. Pain Med Malden Mass. 2016;17(2):239–49. https://doi.org/10.1111/pme.12896. This was a large, comprehensive recent review which noted central steroid response (sleeplessness, flushing, non-positional headache) was the most common adverse effect seen in 2.6% of 16,638 consecutive procedures (both TFESI and ILESI).

2. • Younes M, Neffati F, Touzi M, Hassen-Zrour S, Fendri Y, Béjia I, et al. Systemic effects of epidural and intra-articular glucocorticoid injections in diabetic and non-diabetic patients. Jt Bone Spine Rev Rhum. 2007;74(5):472–6. https://doi.org/10.1016/j.jbspin.2006.10.009. This study found a slight elevation in BP that returned to normal 3 weeks post-ESI and found that both plasma cortisol levels and ACTH were below baseline 21 days after three high dose ESI.

3. •• Friedly JL, Comstock BA, Heagerty PJ, Bauer Z, Rothman MS, Suri P, et al. Systemic effects of epidural steroid injections for spinal stenosis. Pain. 2018;159(5):876–83. https://doi.org/10.1097/j.pain.0000000000001158. This study demonstrates that HPA axis suppression is in fact due to the steroid itself and not other factors related to epidural injection. Longer-acting insoluble corticosteroid formulations such as methylprednisolone or triamcinolone have prolonged systemic absorption of corticosteroid when compared to betamethasone or dexamethasone.

4. Mandel S, Schilling J, Peterson E, Rao DS, Sanders W. A retrospective analysis of vertebral body fractures following epidural steroid injections. J Bone Joint Surg Am. 2013;95(11):961–4. https://doi.org/10.2106/JBJS.L.00844.

5. Singla A, Yang S, Werner BC, Cancienne JM, Nourbakhsh A, Shimer AL, et al. The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery. J Neurosurg Spine. 2017;26(5):645–9.

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