Steroid injections administered to treat back pain may do more harm than good, particularly for older patients, new research suggests. A study published in the Journal of Bone and Joint Surgery found lumbar epidural steroid injection (LESI) increases the risk of bone fragility and spinal fractures.
Patients at greatest 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 lead researcher Shlomo Mandel, M.D., an orthopedic surgeon at Henry Ford Health System. "Through careful screening and monitoring steroid exposure, the risk of a fracture can be minimized. As orthopedic 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."
Most aging adults will experience back pain or a spinal disorder at some time in their lifetime, with nearly 26 million doctor visits a year tied to back problems. Treatment can involve pain medicine, therapy, surgery, or LESI, but relief is often elusive.
The new study — involving more than 50,000 back patients — suggests LESI may be useful in some cases, but should be approached cautiously for those at risk for fractures associated with osteoporosis.
"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,” said Dr. Mandel. "Together with our patient, we review the benefits and risks of alternative treatments before selecting an epidural steroid injection."
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