Here’s a new risk factor to consider when deciding whether to administer a lumbar epidural steroid   injection (LESI) to a patient with back pain: It appears to contribute to later vertebral fractures.
 
That’s the conclusion of a retrospective study published in the June 5 issue of the Journal of Bone and Joint Surgery.
 
For the study, researchers identified more than 50,000 patients who had been assigned diagnosis codes involving the spine. From that broad population, they selected 3,400 who had received at least one LESI. From that group, they randomly selected 3,000 patients as well as an additional 3,000 patients who had not received the injection.
 
There were no significant differences between the injected and non-injected groups with respect to age, sex, race, hyperthyroidism or corticosteroid use.
But in the LESI group, the researchers found a greater likelihood of vertebral fracture. And each successive injection increased the risk of spinal fracture by 21%.
 
“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, ” observed Shlomo Mandel M.D., lead author of the study and an orthopedic surgeon at Henry Ford Health System. “Together with our patient, we review the benefits and risks of alternative treatments before selecting an epidural steroid injection.”