Steroid Injection Linked to Risk of Vertebral Body Fracture

A common approach to treating low back pain is the injection of steroids in the lumbar epidural space.In some cases this may be appropriate, but there are risks involved.

A recent research article shows an increased risk of vertebral body fracture in patients whom had received lumbar epidural steroid injections.

The study from the Journal of Bone & Joint Surgery, randomly selected 3,000 patients who had a lumbar epidural injection and compared them to 3,000 patients who did not undergo the procedure. The study controlled for age difference, gender, corticosteroid use and hyperthyroidism. There were no significant differences found between the two groups.

The researchers of the study found that each successive injection increased the risk of fracture by a factor of 1.21. A single injection has a negligible increased risk of fracture, but what’s important is that most patient receive multiple injections, thereby compounding the risk each time.

In another prospective, double blind study, researchers found that in a population of 73 patients with lumbar radicular symptoms, those who did not respond favorably within 24 hours to the first injection failed to do so with a follow-up injection also. “A decision to use epidural steroids must be made with the realization that we failed to demonstrate its clinical efficacy in this study and that reports of serious complications of this procedure have been published.”

It is recommended that patients undergo at least 6 weeks of conservative, non-invasive care before being considered. For those that have undergone conservative treatment for 6 or more weeks without improvement, epidural injections have been shown to be effective

Extracted from:

  • Mandel et al. A Retrospective Analysis of Vertebral Body Fractures Following Epidural Steroid Injections. J Bone Joint Surg Am, 2013 Jun 05;95(11):961-964.
  • J.M. Cuckler et. al.The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study. J Bone Joint Surg Am, 1985 Jan;67(1):63-66.
  • Buttermann, G. Treatment of Lumbar Disc Herniation: Epidural Steroid Injection Compared with Discectomy. J Bone Joint Surg Am, 2004 Apr;86(4):670-679.