Worth the Risks?

Doctors sometimes use epidural injections when more conservative methods have failed to adequately treat nonspecific low back pain or low back pain caused by inflammation around irritated nerves. Inflammation can occur from a variety of conditions, such as a herniated, or ruptured, disk; nerve compression; and spinal stenosis. The injections typically contain a corticosteroid—usually methylprednisolone—and a local anesthetic to relieve pain from the injection.

Although corticosteroid injections have been used for many decades to treat back pain, the effectiveness and safety of the drugs for this use have not been established, and at this time, corticosteroids are not FDA-approved for this use. In April 2014, the U.S. Food and Drug Administration (FDA) warned that the injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death. According to the FDA, patients should discuss the benefits and risks of epidural corticosteroid injections with their health care providers.

The meningitis scare

In September 2012, the safety of using epidural steroid injections to relieve back pain was further called into question after an outbreak of fungal meningitis emerged among some people who had received the shots. By the end of 2012, more than 372 people had contracted the infection—which caused 39 deaths—as a result of contaminated methylprednisolone injections.

Meningitis occurs when the protective membranes covering the brain and spinal cord swell, either as a result of infection with bacteria or a virus or—in the case of this latest outbreak—with a fungus. Fungal meningitis is rare. The main fungal source of the steroid injection contamination appears to be a black mold found in some steroid vials. All the affected patients were injected with preservative-free methylprednisolone acetate produced by the same compounding pharmacy, the New England Compounding Center.

Fungal meningitis is not contagious. Its symptoms include fever; altered mental status; nausea; light sensitivity; headache; and stiff neck. The appearance of symptoms in the infected patients began within six weeks after their injection, and some patients suffered a stroke after developing the infection.

Other infections

In addition to fungal meningitis, spinal epidural abscess (an infection in the area between the vertebral bones and the spinal cord) and arachnoiditis (a serious inflammation of the arachnoid, a membrane that surrounds the spinal cord) have been reported in some patients at or near the injection site from the same tainted batches of steroids.

The meningitis scare has left many people wondering whether epidural steroid injections are worth the potential risk. The incidence of fungal meningitis acquired from contaminated steroids seems to be isolated, and future risk appears to be low—but cases of abscess and other serious infections from the same tainted batch appear to be on the rise.

Before you decide to begin or continue steroid injections based on the risk of infection, there are other things you should know about the procedure—including whether it’s really reliable when it comes to treating back pain. Current research is raising new concerns about the efficacy and safety of steroid injections.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50; Updated by Remedy Health Media

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 28 Jul 2013

Last Modified: 02 Sep 2015