Epidural Corticosteroids for Sciatica
SOURCE: Dynamic Chiropractic
By Deborah Pate, DC, DACBR
Use of epidural steroid injections has increased dramatically in recent years, despite the fact that studies have failed to demonstrate evidence this procedure is clinically helpful (while other studies suggest it may actually be dangerous).
Considering that lack of evidence – not to mention the terrible 2012 outbreak of fungal meningitis / infections [see sidebar] caused by contaminated vials used for epidural corticosteroid injections – it is prudent at least to take a critical look at this procedure, particularly as it relates to conditions doctors of chiropractic treat.Steroid Injections for Sciatica: Small, Short-Term Relief Only
In a recent meta-analysis of 23 randomized trials involving more than 2,000 patients in which epidural steroid injections were compared with placebo for sciatica, epidural steroid injections produced small, statistically insignificant short-term improvements in leg pain and disability (but not less back pain) compared to placebo. This improvement also was only over a short period of time – two weeks to three months. Beyond 12 months, there was no significant difference between groups. Side Effects Including Skeletal Deterioration, Fracture Risk
Besides infection, there are other side effects associated with epidural steroid injections: bleeding, nerve damage and dural puncture. Then there are side effects associated with the steroid medication, which include the following: a transient decrease in immunity, high blood sugar, stomach ulcers, avascular necrosis (mainly in the hip joint), cataracts and increased risk of fracture.