Do Epidural Injections for Spinal Stenosis Produce Systemic Effects?

In adult medicine we see a great many senior citizens in chronic pain limiting their ability to walk and function due to severe spinal stenosis usually at the lumbar and or sacral spinal level. The bony vertebrae designed to protect the nerve bundles of the spinal cord impinge on the spinal cord as we stand upright and try to walk causing severe pain in the anterior thighs limiting activity and walking.

One of the treatments of choice prior to surgical intervention is injection of the area with an anesthetic pain killer such as lidocaine and corticosteroids. The injections are given by back and pain specialists usually in a series of three shots over time. Usually they provide some pain relief for a period of time. Since the pain is severe and life activity restricting we do not think much about the consequences of these injections beyond the usual risks of bleeding, introducing infection and or getting too close to a nerve or the spinal cord itself.

In a recent study published and then summarized in the online journal “Primary Care “, 400 hundred patients were randomized to receive lidocaine (a pain reliever anesthetic) or lidocaine plus a corticosteroid. The study determined that at three weeks there was a greater than 50% reduction in the measured level of cortisone in over 20% of the participants receiving the steroid injections. The average base line reduction in cortisol level over 3 weeks was over 40% in those receiving methylprednisolone and triamcinolone.

This information is important because it indicates these steroids are being systemically absorbed and suppressing the patient’s own production of cortisol through the adrenal glands especially in those receiving longer acting preparations. The patients are primarily elderly with multiple medical issues requiring us to look closely at whether they need a steroid stress level boost in medication during that time period if they develop an infection or exacerbation of any of their non-back related medical chronic conditions.

It will be important for patients to let their doctors know if they have received epidural steroid injections recently and to be aware of the name of the steroid used so you can be protected from not being able to respond to a stress with a cortisol burst.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: