Safety of epidural steroid injections

Epidural steroid injections (ESI) are a commonly utilized treatment for cervical and lumbar radicular pain. All medical procedures and medications carry an inherent level of risk, that must be balanced with the effectiveness of the treatment to determine the risk to benefit ratio for a patient.

This article will outline the risks of ESIs and in doing so help shed light on the procedural risks versus the risks of the medication. Additionally, it will help differentiate minor adverse events from significant permanent complications.

Catastrophic complications of ESI such as paralysis and stroke unquestionably warrant the recent increased attention given to the safety of these injections. While a single major complication is unacceptable, the relative rate of these major complications must be put in prospective. The true rate is small enough that it is impossible to calculate. All cases are limited to case reports and not detected in even the largest published cohorts of ESI. Moreover, recent advances in medication selection and technique have further reduced the incidence of these very rare complications. Conversely, the more common adverse events are rather minor, generally transient, and mostly occur at incidences of less than 1%.