Back Talk
By Lee Hazen, DC
 

Are epidural steroid injection's of the spine effective?
 
It is an almost daily occurrence that I discuss epidural steroid injections for low back and sciatic pain to my patients.  The literature currently shows the failure of consensus of this treatment, with some physicians suggesting they are the next best thing to surgery for nerve root inflammation as well as those that say these injections should be removed as a treatment option.  The following paper may be very important for you to read. I will only excerpt it so as not to engage copyright, and you may look it up later for further study.
 
This paper gives the following conclusions:
 
1.  Intraspinal steroid therapy is not effective therapy for back pain or radicular symptoms because steroid formulations, placebos, and sham injections have the same outcomes.

2.  When injected, epidural medications may not remain confined to the epidural space and some inaccuracies of placement approach 40%.

3.  The additives of steroid formulations----polyethelyne glycol, benzyl alcohol, and benzalkonium chloride can be toxic to nerves when injected intrathecally (into the spinal cord area).  Further research may disclose that the steroid formulations and mixtures themselves may be toxic to nerves as well because of high osmolalities.

4.  Epidural steroid infusion may result in increased pain, early or late.  There may also be serious complications of arachnoiditis (spinal nerve scarring), spinal infection, or permanent neurological deficits (damage).

5.  Patients should be informed that there is no evidence that epidural steroid injections provide permanent relief of pain.  Serious permanent complications to the spinal cord, nerve roots, or peripheral nerves are rare but certain risk.
 
My own opinion on steroid injections is based on my experience with patients.  I have seen limited benefit from them. Usually patients are told to undergo three such injections at intervals of several weeks.  It is a common that they refuse to return for the second injection due to the failure of relief or sometimes due to increased pain.  I've had equal or superior relief utilizing gentle Cox distraction manipulation, home exercises, targeted muscle therapy, anti-inflammatory electrical stimulation, and nutritional/dietary intervention.
 
Source: Landace WM: Intraspinal steroids: History, efficacy, and controversy with review of United States Food and Drug Administration reports.  J of neurology, Neurosurgery and Psychiatry April 2001