Lumbar Epidural Steroid Injection

The clinical use of lumbar epidural steroid injections has increased dramatically. Although there are certainly beneficial effects to using epidural steroid injections in a treatment regimen for lumbar radicular pain, there is a lack of well designed, placebo-controlled studies to define conclusively specific indications and techniques for different spinal diagnoses. This article reviews the pathophysiology of lumbar radiculopathy and the use of epidural steroid injections as one treatment option, as well as describes their risks and benefits. Based on current literature, we offer an evidence-based perspective regarding rational use of lumbar epidural steroid injections for certain indications and treatment goals.

RISKS

Complications from LESI are rare and can occur as a result of the procedure itself or from the solutions injected. Procedural complications include infection, hematoma, intravascular injection, dural puncture, air embolism, vasovagal syncope, and allergic reaction.

Severe infection is exceedingly rare, with a reported incidence of 0.01%-0.1% for all spinal injections. Most often the result of needle introduction of skin flora with inadequate sterile technique, reported infections include meningitis, epidural abscess, vertebral osteomyelitis, and discitis.

Epidural hematomas are rare in patients with normal clotting factors, with an overall incidence reported to be 1 in 150,000 epidurals, with an unknown proportion developing neurologic injury. A recent case report described spinal cord compression from epidural hematoma after ILESI in a patient with unrecognized idiopathic thrombocytopenic purpura.