epidural long-term side effects

Epidural long-term side effects

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

An epidural steroid injection is an injection inside the bony column of the spine surrounding the dura (the sac that encloses the spinal cord and spinal nerves).

Lumbar epidural injections are a relatively simple technique. They are done several inches from the spinal cord and are unlikely to be accompanied by complications except, perhaps a headache.

Cervical (neck) epidural injections are a very specialized technique done only by skilled and experienced physicians. Epidural steroid injections are useful for a variety of back conditions including sciatica, arthritis, degenerative disc problems, and spinal stenosis.

As with all invasive medical procedures, there are potential risks associated with lumbar (lower back) epidural steroid injections. Generally, however, there are few risks associated with epidural steroid injections and they tend to be rare. Risks may include:

In addition to risks from the injection, there are also potential risks and side effects from the steroid medication. These side effects from an epidural steroid injection tend to be rare. Side effects from steroids are more common when taken daily for several months. Risks and side effects may include:

• Infection. Minor infections occur in 1-2% of all patients. Severe infections are rare occurring in 0.1 to 0.01% of injections.

• A transient decrease in immunity.

• High blood sugar.

• Stomach ulcers.

• Severe arthritis of the hips (avascular necrosis).

• Cataracts.

• Transient flushing.

• Increased appetite.

Possible long term side effects include:

Arachnoiditis, a disabling and painful chronic inflammation of the lining sac that holds the spinal fluid and spinal cord.

Persistent spinal fluid leak. If too large a hole is made in the dural sac (the sac that contains the spinal fluid), slow leakage of spinal fluid may persist. This leads to dizziness, headache, and nausea. A blood patch is often required to treat this. This is a procedure where blood is drawn from the patient and injected into the epidural space to seal the leak.

Avascular necrosis- a condition where the bone dies. This is disabling and affects the shoulder, hip, and knee most commonly.

Aggravation of diabetes. Blood sugars usually bounce up for a short period of time after an epidural injection. Sometimes though in a brittle diabetic, the blood sugars can stay up for several days.

Theoretically, it is possible to have nerve damage. This is extremely rare. We have performed more than 6,000 epidural injections (lumbar, thoracic, and cervical) with no side-effects of this kind.

Paralysis is not a risk since there is no spinal cord in the region of the epidural steroid injection.

Epidural steroid injections should be given using either ultrasound or fluoroscopy guidance.

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