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.
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An epidural steroid injection is an injection into the epidural space. The epidural space lies between the walls of the bony canal that the spinal cord runs down and the dural sac.
Lumbar epidural injections are a relatively simple technique. They are done several inches from the spinal cord and are not likely to be accompanied by complications except a monor headache.
Cervical (neck) epidural injections are a specialized technique done only by skilled and experienced physicians. These do have the potential to cause serious side effects if not done properly. Epidural steroid injections are useful for a variety of back conditions including radiculopathy (pinched nerve, arthritis, degenerative disc problems, and spinal stenosis.
As with all invasive medical procedures, there are potential risks associated with lower back epidural steroid injections. Generally, risks tend to be rare. Risks 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.
• Elevated blood sugar.
• Avascular necrosis of the hips.
• Transient flushing.
• Increased appetite.
Possible long term side effects include:
Arachnoiditis, a disabling, painful, chronic inflammation of the lining sac that holds the spinal fluid and spinal cord.
If too large a hole is made in the dural sac, slow leakage of spinal fluid may persist since the dural sac contains spinal fluid. 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, is disabling and can affect the shoulder, hip, and knee most commonly.
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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