Are the Risks of Epidural Spinal Injections Worth the Potential Benefits?
- Julian Simpson
- Jun 9
- 2 min read
Are the Risks of Epidural Spinal Injections Worth the Potential Benefits?
Despite the lack of approval from the FDA (Food and Drug Administration), cervical (neck) and lumbar (low back) epidural spinal injections are frequently performed in the United States as a common intervention aimed at alleviating back pain and addressing painful radiculopathy. These injections are often considered by healthcare providers when patients experience chronic pain that significantly impacts their quality of life, particularly when other conservative treatments have failed to provide adequate relief.
The three major types of injections that are commonly utilized in this context include:
interlaminar/translaminar (commonly referred to as ESI),
transforaminal (known as TFESI), or
caudal injections, which are administered at the base of the spine.
While these procedures are generally considered minimally invasive, they are not without risks. Acute post-injection adverse events can manifest immediately or within a 72-hour period following the injection.
These symptoms can vary significantly in severity and may include:
hypotension, a condition characterized by abnormally low blood pressure,
acute respiratory distress, which can lead to difficulty breathing,
chest pain, which may raise concerns for cardiac issues,
upper extremity numbness and weakness, which can indicate nerve involvement,
paresthesias, or abnormal sensations such as tingling,
paralysis, a severe complication that can result from nerve damage, and
fevers, which may suggest an inflammatory response or infection.
Research has shown that epidural cervical and lumbar ESI or TFESI spinal injections often demonstrate minimal to no short-term benefits, and they show no long-term benefits for the treatment of cervical and/or lumbar pain or radiculopathy when compared to placebos.
(A placebo is defined as a substance that has no therapeutic effect, typically used as a control in clinical trials to evaluate the efficacy of new drugs.)
This raises a significant question about the overall effectiveness of these procedures in relation to their associated risks. Patients considering epidural spinal injections must weigh the potential for temporary relief against the possibility of serious complications and the lack of substantial evidence supporting long-term benefits. In the context of pain management, it becomes crucial for both patients and healthcare providers to engage in thorough discussions regarding the appropriateness of these interventions, exploring all available options for treatment, including physical therapy, medication, and alternative therapies, to ensure a comprehensive approach to managing pain.
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Reference
Epstein NE, Agulnick MA. Perspective: Risks/adverse events for epidural spinal injections. Surg Neurol Int. 2024 Sep 13;15:328. doi: 10.25259/SNI_701_2024. PMID: 39372999; PMCID: PMC11450889.
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