Most aging adults will experience back pain or a spinal disorder at some time in their life. In fact, about 25.8 million visits were made to physicians’ offices due to primary back problems. Treatment focuses on pain relief and is available in both non-surgical (medication or physical therapy) and surgical forms.A retrospective study in the June 5th issue of the Journal of Bone and Joint Surgery (JBJS) looked
at one type of back treatment– a lumbar epidural steroid injection
(LESI) – and whether or not that treatment had an impact on bone
fragility and vertebral fractures (spinal fractures). A higher number of
injections was associated with increased risk. Authors
concluded that LESIs may lead to increased bone fragility over time,
and while injection therapy is useful in some cases, it should be
approached cautiously for patients at risk for fractures associated with
osteoporosis. Patients at a high risk for vertebral fractures after an epidural
injection include older women, those who have had an earlier fracture,
those who smoke and those who are underweight. Young and active male patients have a lower risk of vertebral fracture.
“In the appropriate setting, and for the right patient, LESI provides
effective symptomatic relief and improved level of function, said Shlomo
Mandel, MD, MPH, lead author of the JBJS study and orthopaedic surgeon
at Henry Ford Health System. “Through careful screening and monitoring steroid exposure, the risk of a fracture can be minimized. As
orthopaedic surgeons who specialize in spine, we know there is a role
for injection therapy, but the challenge is to make sure it is
administered safely and still provide long-term benefits.”
Study Details and Key Findings:
· Authors
identified a total of 50,345 patients who had medical diagnosis codes
involving the spine and from that group, a total of 3,415 patients had
received at least one LESI.
· 3,000 patients were randomly selected from the 3,415 injected population, and then 3,000 patients from the non-injected group were selected as a control group. The incidence of vertebral fractures was assessed.
· There
was no significant difference between the injected and non-injected
groups with respect to age, sex, race, hyperthyroidism, or
corticosteroid use.
· An
increasing number of injections were associated with an increasing
likelihood of fractures, and each successive injection increased the
risk of spinal fracture by 21 percent.
“It’s important to remember that when contemplating an epidural steroid
injection a physician should have a symptomatic history, physical
findings and corresponding imaging of direct pressure on a single nerve,
” added Dr. Mandel. “Together with our patient, we review the benefits
and risks of alternative treatments before selecting an epidural steroid
injection.” Dr. Mandel and his co-authors agree that more research is warranted on this relationship. They have a prospective study on vertebral fractures and injection therapy in the works. Source: Journal of Bone and Joint Surgery
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