Steroid injections have come under fire in recent years. First, study results called into question their effectiveness in managing lower back pain. Then, hundreds of people were affected by a meningitis outbreak in 2012 linked to tainted steroid injections. Finally, they have been linked to an increased risk of bone fracture. A new study sought to assess how effectively these injections helped patients with spinal stenosis manage pain.
Stenosis can occur in either the cervical spine in the neck or the lumbar spine in the lower back. Lumbar stenosis is the more common; according to Spine-Health.com, about three-fourths of all cases occur in the lumbar spine. Stenosis involves the compression of nerve roots that exit the spinal canal. There are three types, named for the location of compression:
2) Far Lateral: This type of stenosis occurs beyond the foramen. Compression can be caused by a bulging or herniated disc, or by a bone spur.
3) Central: This involves obstruction of the nerves within the spinal canal. It is generally caused by a bulging disc and ligament overgrowth within the spine.
Spinal stenosis is generally a progressive condition. In mild cases or early on, it may cause only minor irritation. As time goes on, or in severe cases, nerve damage can occur. If nerve damage is occurring, surgery is necessary. For all other cases, physical therapy is generally prescribed to strengthen muscles around the spine to help support it. Anti-inflammatory medication is often prescribed, sometimes in the form of steroid injections.
There were two significant results of the steroid injection study: 1) Over a four year period, those who had surgery or non-steroidal conservative treatment did better than those who opted for steroid injections; and 2) The patients who did go on to receive surgery after using steroid injections had worse outcomes than those who skipped the injections.
See more on this study at www.nlm.nih.gov.
Steroid injections may be a helpful pain management tool for some, but they are falling from grace in the medical literature. Studies like the one above suggest that steroids shouldn’t be a patient’s first approach to back pain management.