The Effectiveness of Epidural Steroid Injections for Spinal Stenosis

by LMatthews on September 12, 2010


Dural Leak

Dura Leak

In our post last week we discussed the use of epidural injections for spinal stenosis pain, this week we will take a look at the effectiveness, limitations, side effects and risks involved in the use of steroid injections as a spinal stenosis treatment.

Epidurals can be very effective for relieving the chronic pain associated with spinal stenosis. Epidural steroid injections are usually used for leg pain rather than back pain, or neck pain residing higher up in the spine. The effects last for 2-3 weeks in the majority of people, but it is as yet unknown how well injections for spinal stenosis and other spine conditions work over extended time periods. One of the benefits outside pain relief is it may help some patient delay spinal stenosis surgery or even remove its necessity.

Limitations, Side Effects and Risks of Epidural Steroid Injections

Unfortunately there are potential side-effects to epidural steroid injections. These include the possibility of complications with the procedure itself, namely a risk of infection at the injection site. Other side effects are usually fairly minor in nature, but as the longer-term effects of epidurals have not been studied it is inadvisable to have more than three injections in a 12 month period with most doctors recommending no more than one in a 2 month period. Three or four injections at one site are the normal limit advised for most patients.


Side effects can include tenderness in the area for a few days at the site of injection, nausea and vomiting, dizziness, and headaches. There is also a very small chance of spinal fluid leakage, although the use of the fluoroscope normally minimizes this risk. Epidurals are usually avoided in the cervical spinal stenosis as the structures here are harder to navigate safely. Oral steroids may be an option instead of a steroidal injection.

As the steroids are being injected into a specific space there is only a small amount of corticosteroid which reaches systemic circulation. Side effects in the case of these circulating steroids include water retention, weight gain, and the potential for blood sugar control being compromised (particularly in diabetics).

Rare, but dangerous side effects also include nerve root injury, bleeding, infection, and meningitis. Those with immune system problems are usually ill-advised to have epidural steroid injections, and those with mental health disorders also have a higher risk of complication with this procedure. If the patient has an infection at the time of the procedure then they should postpone their treatment until the infection has cleared. Those with a congenital form of spinal stenosis are also advised against epidural injections as the corticosteroids may exacerbate their condition, with increased pain and numbness.

Spinal Stenosis Pain Management

When the pain and symptoms of spinal stenosis are persistent, epidural steroid injections are just one option in the treatment and management of spinal stenosis. If patients feel it may benefit them they should discuss this option with their health care professional to see if it is appropriate for their circumstances. Epidurals should not be used in isolation, instead they should be incorporated into a management program and facilitate rehabilitation (alongside exercises for spinal stenosis) rather than acting as a short-term substitute for it. If an epidural is not effective the physician may suggest another injection later at a different site. A review of the benefits of epidural steroid injections by Botwin (2002) found that the transforaminal injection site provided significant short and long-term improvements in patients as opposed to other injection sites. If long-term benefits are felt then the likely mechanism is that the cycle of inflammation has been broken by the steroids, allowing the body time to repair and recover.

References

North American Spine Society, (2007), Diagnosis and treatment of degenerative lumbar spinal stenosis: Evidence-based clinical guidelines for multidisciplinary spine care. Available online: http://www.spine.org/Documents/NASSCG_Stenosis.pdf.
Isaac, Z., et al, (2005), Lumbar spinal stenosis, In Koopman, W.J., ed. Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp.2087–2092, Philadelphia, Lippincott, Williams, and Wilkins.
Botwin, K.P., Gruber, R.D., Bouchlas, C.G., Torres-Ramos, F.M., Sanelli, J.T., Freeman, E.D., Slate, W.K., Rao, S., (2002), Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study, Am J Phys Med Rehabil, Vol.81, no.12, pp.898-905.

Written by Leigh Matthews

{ 8 comments… read them below or add one }

Ernestine October 24, 2010 at 8:56 am

I had a selective nerve root injection. It was painful. It was done on the left side on the L3 L4 L5. After the injection mymleft leg was numb because of the feeling in the nerve i was getting going down the leg. After I was done and they were taking me to the other room to rest I started to get a metal taste in my mouth. After that I could barely talk right, i began to feel as if I was High on drugs, I also felt very cold and could hardly breathe because it felt like someone was standing on my chest. It had gotten into my blood stream. I do not see any side effects about it getting into the blood stream and what it can do. I was told that it was cardiovascular.

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admin October 24, 2010 at 9:15 am

Ernestine, Thank you for your comment and experience. May others contact you via email with questions?

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Ernestine October 28, 2010 at 5:01 am

Yes I would love to hear from others who have had the same side effects as I had and tenderness in the area where they received their needles. I hav had injections on both sides with different medicines..% needles on the right and 3 on the left with anesthetic numbing medicine and steroids,

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Harriett November 28, 2011 at 8:44 pm

I had a shot last Tuesday and the metal taste in my mouth began on Thursday and hasn’t left yet. Today is Monday. The metal taste seems to be getting stronger and I am not sure what to do about it.

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Nancy November 11, 2010 at 4:27 pm

Ernestine, I work as a nurse in a surgical center. The injections contain a steroid and lidocaine. The lidocaine is what was absorbed into your system and caused your symptoms. The metallic taste in your mouth is a very common symptom as well as cerebral and cardiovascular symptoms. The steroids may cause other issues like mood changes and blood sugar instability. If the injections work and you decide to have more, I would just let the doctor know that you are very sensitive to lidocaine and they could maybe give you less or none at all? The lidocaine is really just for short term pain relief and wears off. It is the steroid that is working to reduce swelling. I have had patients swear by these injections. I wouldn’t be afraid to explore them if it is recommended.

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Harriett November 28, 2011 at 8:46 pm

Do you know how long the metal taste lasts? I had the shot a week ago Tuesday. The metal taste in my mouth began last Thursday and is still present. Today is Monday.

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Joshua July 23, 2011 at 1:57 pm

I had an epidural injection of dexamethasone (w/lidocaine and a dye of some sort) and an oral valium under the tongue before hand. I suffer from anxiety and other mental issues already, but since the injection I’ve had a lot of anxiety, my heart starts beating fast for no reason which scares me since I have been diagnosed with atrial fibrillation. I feel irritable one moment, happy the next, I feel like crying a lot or sleeping. I know I should call my doctor, but before doing so, I wanted to know if anyone else had experienced this, if it is a normal adverse effect? I did not think there was a lot systemic action because of how localized the injection is. (T1) I did read about weight gain but my dr said it was a low dose. Those who get weight gain, I know could be because lack of activity due to injury, but there is a sugar/cortisone change which causes weight gain.. how long does that last? How long will I feel extra crazy??

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M F Dalhaus April 25, 2012 at 11:55 am

I have had epidural injections for years. The first ones used to last for a year to six months. The last one I had this year lasted about three weeks and I am debating whether to have another one as I definitely don’t want another surgery ( had three) I have lived with this for years. I am still active, do exercises every morning and manage to get thru the day inspite of the pain. Could be I am living too long.! I’ll be 93 in June. Halelujah!!!

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