Time to reconsider steroid injections in the spine?

Harris, Ian A; Buchbinder, Rachelle

doi:10.5694/mja12.11696

Topics

Health services administration

Steroid injections to the spine provide no advantage over placebo, but do carry risks of harm

1 South Western Sydney Clinical School, University of New South Wales, Sydney, NSW.
2 Monash Department of Clinical Epidemiology, Cabrini Health, Melbourne, VIC.
3 Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, VIC.

Correspondence: ianharris@unsw.edu.au

Competing interests:

No relevant disclosures.

1. Friedly J, Chan L, Deyo R. Increases in lumbosacral injections in the Medicare population: 1994 to 2001. Spine (Phila Pa 1976) 2007; 32: 1754-1760.
2. Medicare Australia. Medicare item reports. 2012. https://www.medicareaustralia.gov.au/statistics/mbs_item.shtml (accessed Jul 2011).
3. Staal JB, de Bie R, de Vet HC, et al. Injection therapy for subacute and chronic low-back pain. Cochrane Database Syst Rev 2008; (3): CD001824.
4. Benoist M, Boulu P, Hayem G. Epidural steroid injections in the management of low-back pain with radiculopathy: an update of their efficacy and safety. Eur Spine J 2012; 21: 204-213.
5. Armon C, Argoff CE, Samuels J, Backonja MM; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: use of epidural steroid injections to treat radicular lumbosacral pain: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2007; 68: 723-729.
6. Tafazal S, Ng L, Chaudhary N, Sell P. Corticosteroids in peri-radicular infiltration for radicular pain: a randomised double blind controlled trial. One year results and subgroup analysis. Eur Spine J 2009; 18: 1220-1225.
7. Manchikanti L, Cash KA, McManus CD, et al. Preliminary results of a randomized, equivalence trial of fluoroscopic caudal epidural injections in managing chronic low back pain: Part 4-Spinal stenosis. Pain Physician 2008; 11: 833-848.
8. Manchikanti L, Singh V, Cash KA, et al. Preliminary results of a randomized, equivalence trial of fluoroscopic caudal epidural injections in managing chronic low back pain: Part 2-Disc herniation and radiculitis. Pain Physician 2008; 11: 801-815.
9. Manchikanti L, Cash KA, McManus CD, et al. Preliminary results of a randomized, equivalence trial of fluoroscopic caudal epidural injections in managing chronic low back pain: Part 1-Discogenic pain without disc herniation or radiculitis. Pain Physician 2008; 11: 785-800.
10. Wybier M, Gaudart S, Petrover D, et al. Paraplegia complicating selective steroid injections of the lumbar spine. Report of five cases and review of the literature. Eur Radiol 2010; 20: 181-189.
11. Nelson DA, Landau WM. Intraspinal steroids: history, efficacy, accidentality, and controversy with review of United States Food and Drug Administration reports. J Neurol Neurosurg Psychiatry 2001; 70: 433-443.
12. Manchikanti L. Role of neuraxial steroids in interventional pain management. Pain Physician 2002; 5: 182-199.
13. Mandel S, Schilling J, Peterson E, et al. A retrospective analysis of vertebral body fractures following epidural steroid injections. J Bone Joint Surg Am 2013; 95: 961-964.
14. Centers for Disease Control and Prevention. Multistate fungal meningitis outbreak investigation. Current situation. http://www.cdc.gov/HAI/outbreaks/currentsituation (accessed Nov 2012).
15. Savigny P, Watson P, Underwood M; Guideline Development Group. Early management of persistent non-specific low back pain: summary of NICE guidance. BMJ 2009; 338: b1805.

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