Complications associated with epidural steroid injections

Abstract

Background and objectives: Warnings about the hazards of epidural steroid injections occasionally appear in both medical and lay literature despite a lack of objective data to support such concerns. This literature review was undertaken to survey reports of adverse reactions associated with that procedure.

Methods: The following types of publications from peer-reviewed medical literature was surveyed: reports on series of epidural and subarachnoid steroid injections for sciatica; reports of adverse effects of epidural and subarachnoid steroid injections for sciatica; review articles on epidural and subarachnoid steroid injections; and studies of the behavioral and histologic effects of epidural steroids and their vehicle in animals.

Results: Several cases of aseptic meningitis, arachnoiditis, and bacterial meningitis and one case of conus medullaris syndrome have been reported after subarachnoid steroid injections. Most of these complications occurred after multiple subarachnoid injections. Two cases of epidural abscess, one case of bacterial meningitis, and one case of aseptic meningitis have been reported following epidural steroid injections. Subarachnoid drug placement could not be ruled out in the meningitis cases.

Conclusions: There are few published reports of serious complications following epidural steroid injections. There are a few published reports of complications following subarachnoid steroid injections, most of which were associated with multiple injections over a prolonged time period.