Epidural steroid injection associated with increased spinal fractures

Print Article

Most aging adults will experience back pain or a spinal disorder at some time in their life. In fact, about 25.8 million visits were made to physicians' offices due to primary back problems. Treatment focuses on pain relief and is available in both non-surgical (medication or physical therapy) and surgical forms.

A retrospective study in the June 5 issue of the Journal of Bone and Joint Surgery (JBJS) looked at one type of back treatment - a lumbar epidural steroid injection (LESI) - and whether or not that treatment had an impact on bone fragility and vertebral fractures (spinal fractures). A higher number of injections was associated with increased risk. Authors concluded that LESIs may lead to increased bone fragility over time and while injection therapy is useful in some cases, it should be approached cautiously for patients at risk for fractures associated with osteoporosis.

Patients at high risk for vertebral fractures after an epidural injection include older women, those who have had an earlier fracture, those who smoke and those who are underweight. Young and active male patients have a lower risk of vertebral fracture.

"In the appropriate setting, and for the right patient, LESI provides effective symptomatic relief and improved level of function," said Shlomo Mandel, MD, MPH, lead author of the JBJS study and orthopaedic surgeon at Henry Ford Health System. "Through careful screening and monitoring steroid exposure, the risk of a fracture can be minimized. As orthopaedic surgeons who specialize in spine, we know there is a role for injection therapy, but the challenge is to make sure it is administered safely and still provide long-term benefits."

Study details and key findings:

* Authors identified a total of 50,345 patients who had medical diagnosis codes involving the spine and from that group, a total of 3,415 patients had received at least one LESI.

* 3,000 patients were randomly selected from the 3,415 injected population and 3,000 patients from the non-injected group were selected as a control group. The incidence of vertebral fractures was assessed.

* There was no significant difference between the injected and non-injected groups with respect to age, sex, race, hyperthyroidism, or corticosteroid use.

* An increasing number of injections were associated with an increasing likelihood of fractures, and each successive injection increased the risk of spinal fracture by 21 percent.

"It's important to remember that when contemplating an epidural steroid injection, a physician should have a symptomatic history, physical findings and corresponding imaging of direct pressure on a single nerve," added Dr. Mandel. "Together with our patient, we review the benefits and risks of alternative treatments before selecting an epidural steroid injection."

Dr. Mandel and his co-authors agree that more research is warranted on this relationship.

Source: American Academy of Orthopaedic Surgeons

Dr. Wayne Fichter is the lead doctor at Natural Spine Solutions, with over 15 years of experience treating families. He also has been the lead doctor in handling serious neck and back problems through non-surgical spinal decompression. Call (208) 966-4425 for all of your spinal and wellness needs.

Print Article

Read More Healthy Community

ADVERTISING: Advertorial GEORGE BALLING: Our trip to wine country

July 10, 2019 at 5:00 am | Coeur d'Alene Press Mary and I frequently get asked questions like what is our favorite wine? Tough to answer there is never just one. Or, when you go to wine country, who do you go visit? This one is easier to answer...

Comments

Read More

ADVERTISING: Advertorial WENDY CUNNINGHAM: Natural solutions for ear infections

July 10, 2019 at 5:00 am | Coeur d'Alene Press Ear problems can be extremely painful, especially in children. Millions of children visit doctors for ear infections (otitis media) each year. It accounts for more than 35 percent of all pediatric vi...

Comments

Read More

ADVERTISING: Advertorial HOLLY CARLING: Dangers of heartburn and reflux

July 10, 2019 at 5:00 am | Coeur d'Alene Press With more than 15 million Americans on prescriptions for heartburn and reflux, and many more on over-the-counter (OTC) medications, we can say we have a real problem here! We need to digest what we ...

Comments

Read More

ADVERTISING: Advertorial JONATHAN M. SASSER: Declare independence over your health!

July 03, 2019 at 5:00 am | Coeur d'Alene Press Perhaps the most fundamental idea in the foundation of our country is that of freedom and independence. One surprising freedom that many of us have relinquished is that over our health. The current s...

Comments

Read More

Contact Us

(208) 664-8176
215 N. Second St
Coeur d'Alene, Idaho 83814

©2019 The Coeur d'Alene Press Terms of Use Privacy Policy
X
X