A study published online in the Journal of Bone and Joint Surgery found that spinal injections of steroids used to treat and relieve back pain, increased bone fragility in the vertebrae of older patients. Every such subsequent treatment given, called a translaminar lumbar epidural steroid injection (LESI), increased the risk of vertebral fracture. A secondary analysis that considered the possibility of more than one fracture in a single patient produced similar results. The research was conducted by orthopedic spine surgeon Shlomo Mandel and his co-authors from the Henry Ford Health System.
The study was based on the records of 3,000 patients 50 years-old and up who had received at least one spinal steroid injection for compressive neuropathic pain. They compared this group to 3,000 comparable patients who had not received a LESI for their pain. The end of the evaluation period was five years or the end of the documented medical history, whichever was sooner.
What Exactly is in Steroid Injections?
Steroids are organic compounds naturally produced by the human body. In humans, steroids are used to produce several different hormones that are important to the body’s proper functioning. There is also a class of drugs called anabolic steroids, which are used to increase muscle mass and improve athletic performance. But steroids can also be manufactured for medicinal use, the most commonly used are corticosteroids, injected to treat pain.
How do Corticosteroids Effect the Body?
Natural corticosteroids are produced by the body’s adrenal glands and are responsible for the flight or fight response. They are also integral in maintaining a healthy immune response and for metabolizing protein and carbohydrates. But mostly they control inflammation, which is why steroid injections are so popular among those suffering from chronic pain.
Corticosteroids are not painkillers, though, like Demerol. They ease pain by reducing or controlling the inflammation associated with certain conditions. There are two types of steroid injections typically used for pain relief: epidural and articular. An epidural steroid injection goes into the base of the spinal column between the protective covering of the spinal cord, called the dura, and the vertebrae. An articular steroid injection is administered into the shoulder, knee, hip, or ankle.
Steroid use is closely monitored and in general injections are only given once every two to four weeks for usually no longer than three months at the most. Combined with chiropractic care, many people can experience a significant reduction in pain after a course of steroid injections. Currently, steroid injections are reserved for those patients suffering from severe, persistent pain in the neck, back, arm or leg that has not responded to more conservative treatments.
What Physicians Know About Steroid Injection Use
While researchers already knew steroids could disrupt bone stability and strength, the correlation between LESI and risk of vertebral fracture had not been studied very much, which is what prompted these researcher to investigate.
There is no doubt the injections help many people but where the findings are of clinical importance and concern is that many patients suffering from sciatica and spinal stenosis happen to be elderly and they would be the group most at risk because they already tend to exhibit increased skeletal fragility. Previous studies have suggested that vertebral fractures are associated with a higher risk of mortality for both men and women.
The researchers caution patients from completely dismissing the value of LESI for all patients, especially younger individuals. But elderly people should have a discussion with their doctor to discuss the risks of LESI before proceeding with the treatment.