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Thu, Dec 18, 2014

LIVING WELL: Effectiveness of epidural steroids questioned


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Recent news involving the deaths of dozens of patients from spinal meningitis resulting from epidural injections has brought this treatment option to the forefront of medical news.  

Many patients have received epidural steroid injections for spinal conditions, including sciatica, in the past few years. The procedure is widely practiced.

Recently hundreds of patients became ill or died as a result of receiving epidural injection of a steroid drug that was contaminated.  

The Centers for Disease Control have reported more than 450 cases of fungal spinal meningitis and dozens of deaths resulting from the use of tainted medication. The number of cases and death toll is certain to rise in coming months.

Investigation has revealed that the steroids used in the fatal injections originated from what has been called a sub-standard compounding pharmacy that supplied multiple clinics in at least 19 states including Tennessee.

The medication was contaminated with a fungus apparently as a result of inappropriate manufacturing procedures. As a result of this alleged failure to maintain proper conditions, many of the patients that don’t die could endure a lifetime of medical complications.

This news story has brought attention to bear on the procedure of epidural steroid injections.

The question has been raised as to whether it is beneficial enough to merit the risk of possible complications.

The procedure of epidural steroid injection has been practiced for decades. Although the news of the unfortunate patients that received the tainted drugs is alarming, the number involved is a tiny fraction of the people that have safely received the treatment.

Yet, some doctors are beginning to question whether the procedure should continue to enjoy such wide popularity.

According to an article published earlier this week (Nov. 13) in Annals of Internal Medicine, the short-term benefit of epidural injection of steroids for sciatica was minimal, and there was no significant long-term benefit for either lower back pain or sciatica.

Other research efforts have found similar outcomes.  

Although the heartbreaking stories of the patients that died of fungal meningitis related to the epidural steroid injections involving the drugs manufactured by the Massachusetts compounding pharmacy represent the isolated failure of a particular company to provide a safe product, there are other risks to be considered.

Known risks of epidural steroid injections although rare can include infection, nerve damage and accidental puncture of the spinal dura.

According to an article published in 2011 by Stephen E. Abram, MD, and Quinn H. Hogan, MD, both anesthesiology professors at The Medical College of Wisconsin in Madison, Wisconsin, “The most likely causes of spinal cord injury following epidural steroid injection are epidural bleeding, epidural abscess, direct spinal cord trauma, and embolization of particulate matter into the arterial supply of the cord.”

The authors went on to point out that, “There is little evidence that they (epidural steroid injections) reduce the need for spine surgery or that they improve long-term outcomes.”

 Although there have been successful outcomes for patients undergoing the procedure, the risks are considered by some doctors to outweigh the potential benefits.

Although generally regarded as safe the procedure involves placing a needle within millimeters of the delicate spinal tissues. The steroid is injected into the miniscule space between the interior of the bony structure surrounding the spinal nerves and the outer covering of the nerves (dura).  

In some cases patients will feel immediate relief. In others they will receive no benefit. If partial relief is obtained a second and possibly third injection may be done a few weeks later. Generally doctors recommend no more than three epidural injections be administered within six months time due to concerns about side effects.

 There is no universally successful treatment for lower back pain and complications such as sciatica. The spine is such a complicated biomechanical structural system that each individual patient has the potential to respond to any treatment in a widely variable way. The delicacy of the neurological tissues involved mandates a conservative approach in most cases.
 
 
 
Tagged under  Health Care, Living Well, Mark Kestner, Medicine, Steroids, Voices



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