Epidural Steroid Injections: Risks and Side Effects

Epidural Steroid Injections: Risks and Side Effects

There are several risks associated with epidural injections, and although they are all relatively rare, it is worth discussing each with the professional who will be conducting the procedure to determine the incidence of prevalence in their practice.

Potential Risks of Epidural Steroid Injections

As with all invasive medical procedures, there are potential risks associated with lumbar epidural steroid injections. In addition to temporary numbness of the bowels and bladder, the most common potential risks and complications include:

  • Infection. Severe infections are rare, occurring in 0.1% to 0.01% of injections.
  • Epidural Steroid Injection. Click to enlarge
  • Dural puncture ("wet tap"). A dural puncture occurs in 0.5% of injections. It may cause a post-dural puncture headache (also called a spinal headache) that usually improves within a few days. Although infrequent, a blood patch may be necessary to alleviate the headache. A blood patch is a simple, quick procedure that involves obtaining a small amount of blood from a patient from an arm vein and immediately injecting it into the epidural space to allow it to clot around the spinal sac and stop the leak.
  • Bleeding. Bleeding is a rare complication and is more common for patients with underlying bleeding disorders.
  • Nerve damage. While extremely rare, nerve damage can occur from direct trauma from the needle, or from infection or bleeding.
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Possible Side Effects of Lumbar Epidural Steroid Injection

In addition to risks from the injection, there are also potential side effects from the steroid medication itself. These tend to be rare and much less prevalent than the side effects from oral steroids. Nonetheless, reported side effects from epidural steroid injections include:

  • Localized increase in pain
  • Non-positional headaches resolving within 24 hours
  • Facial flushing
  • Anxiety
  • Sleeplessness
  • Fever the night of injection
  • High blood sugar
  • A transient decrease in immunity because of the suppressive effect of the steroid
  • Stomach ulcers
  • Severe arthritis of the hips (avascular necrosis)
  • Cataracts

When to Report Epidural Side Effects to a Doctor

While physicians will have different approaches to patient follow-up depending on their practice and the patient's clinical situation, some conditions that always warrant a call to a doctor following an epidural steroid injection include:

  • Experiencing a painful headache while sitting up or standing that feels better after lying down, which may indicate a dural puncture
  • Having a fever of 101 degrees or greater for more than 24 hours, which may be indicative of infection
  • Losing function or feeling in the legs or arms
  • Loss of bowel or bladder control (meaning either the inability to produce or hold urine or stools) after the local anesthetic and temporary numbness wear off
  • Severe pain not controlled by over-the-counter pain medication or other measures used in the past

All of these symptoms are atypical effects, and need to be assessed and addressed immediately by a professional.

In general, epidural steroid injections are a low risk, useful, non-surgical tool to combat lower back pain and sciatica (radicular pain) caused by inflammation. A conservative analysis of patient outcomes suggests that at least 50% of patients will experience pain relief, although the exact degree of relief enjoyed depends on a number of factors. Their relative safety and efficacy makes epidural steroid injections an integral part of the non-surgical treatment of low back and radicular pain.

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Article written by: Richard A. Staehler, MD