Dominic Stone
Epidural steroid injections are a common treatment for chronic pain, particularly in the back and legs. The injections deliver anti-inflammatory medication to the epidural space around the spinal nerves, reducing inflammation and providing pain relief. While generally safe, there are risks and side effects associated with the procedure. These can include headaches, hot flashes, rashes, insomnia, and increased blood sugar. In rare cases, more severe consequences can occur, such as nerve damage, seizures, and breathing difficulties. The injections may also cause muscle spasms, though this is not specifically mentioned in the sources.
Can Epidural Steroid Injections Cause Muscle Spasms?
| Characteristics | Values |
|---|---|
| Muscle Spasms | No explicit mention |
| Pain Relief | Temporary |
| Side Effects | Mild injection site pain, temporary worsening of usual pain, flushing, insomnia, increased blood sugar, headache, hot flashes, rash, seizures, abnormal sensations, loss of sensation, loss of bowel and bladder control, low blood pressure, decreased heart rate, nausea, vomiting, dizziness |
| Risks | Infection, bleeding, nerve damage, negative reaction to medication, haematoma, bruising, permanent neurological deficit, bone weakening, paralysis, death |
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Infection risks
While lumbar epidural steroid injections are generally considered safe, they do carry the risk of infection, as with any injection procedure. Infections may occur generally within the body (systemic infection), affect the brain and/or spinal cord, or occur locally in the area of the injection. Here are some of the infection risks associated with epidural steroid injections:
Epidural Abscess
An epidural abscess is a collection of pus in the epidural space, which is the area around the spinal cord where the injection is administered. This type of infection can cause serious complications and requires immediate medical attention.
Meningitis
Meningitis is an inflammation of the brain and spinal cord membranes. It is a rare but serious complication of epidural steroid injections. Symptoms of meningitis may include headache, fever, neck stiffness, and sensitivity to light.
Osteomyelitis or Discitis
Osteomyelitis is an infection of the vertebral bone, while discitis is an infection of the disc. These infections can cause severe pain and require prompt medical treatment.
Soft Tissue Abscess
A soft tissue abscess is a collection of pus that forms within the soft tissues at the injection site. This type of infection is typically caused by microbes from the patient's skin.
Systemic Absorption
If the steroids enter the bloodstream, it can lead to systemic absorption, which can cause problems such as loss of bone density, infection, and high blood sugar.
It is important to note that infection is not a common side effect of epidural steroid injections, and healthcare providers take precautions to minimise the risk of infection, such as thoroughly cleaning the injection site and using imaging guidance to ensure proper needle placement. However, as with any medical procedure, there is always a small risk of infection.
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Nerve damage
Although rare, nerve damage is a potential risk of receiving epidural steroid injections. This can occur if the needle hits a nerve during the injection. In most cases, this will only trigger a brief tingling sensation, pins and needles, or a mild shooting pain. However, if the needle is not repositioned, it can lead to further problems, including permanent nerve damage.
The likelihood of nerve damage occurring as a result of an epidural steroid injection is very low. Research estimates that permanent harm occurs in less than 1 in 50,500 (0.002%) spinal or epidural injections. In the context of epidural steroid injections, nerve damage is most likely to occur if the cauda equina nerves at the base of the spinal cord are damaged. This can result in a medical emergency called cauda equina syndrome, which causes loss of bowel and bladder control and must be treated immediately to prevent paralysis of the lower body.
Another potential complication of epidural steroid injections is nerve root damage, which can cause increased pain down the leg. This is distinct from cauda equina syndrome, which specifically involves damage to the cauda equina nerves. Nerve root damage can also result in chronic pain and permanent neurological deficits due to spinal cord injury from the epidural injection.
In extremely rare cases, epidural steroid injections can cause serious infections that may lead to permanent nerve damage. This can result in permanent loss of feeling (paralysis or paraplegia) in the legs. Paraplegia occurs in less than 1 in 141,500 (0.0007%) cases of spinal or epidural injections. Other rare but serious neurological problems associated with epidural steroid injections include an inability to swallow, vertigo, and worsening neck pain.
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Muscle weakness
Epidural steroid injections are typically used to manage chronic lumbar radicular pain, which is caused by spinal nerve root inflammation and irritation in the lower back. This pain can radiate from the lower back down to the calf and/or foot. Lumbar radicular pain is often referred to as sciatica.
While epidural steroid injections are generally considered safe, they can, in rare cases, cause muscle weakness. This muscle weakness is a potential side effect of the injection procedure itself and is not necessarily indicative of any serious complications. However, it is important to be aware of this possibility.
The injections aim to reduce inflammation and open up nerve passages to alleviate pain. While they are often effective, they do not cure the underlying condition causing the pain. The injections are intended to provide short-term pain relief, typically lasting up to six months, so patients can begin or continue physical therapy to promote long-term pain management.
It is worth noting that the injections carry some risks and potential side effects, such as infection, negative reactions to medications, bleeding, nerve damage, and temporary loss of bladder and bowel control. In rare cases, lumbar epidural steroid injections can lead to long-term complications, including permanent neurological deficits due to spinal cord or nerve root damage.
To minimise risks, healthcare providers limit patients to two to three epidural steroid injections per year. The injections are generally considered safe when performed by skilled professionals, and side effects are usually temporary and tolerable.
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Headaches
Spinal headaches typically develop within two to three days of a lumbar puncture, but they can also occur months later or up to five days after the procedure in the case of PDPH. The pain is usually intense and throbbing, and it worsens when sitting or standing and improves when lying down. Other symptoms include neck pain or stiffness, vision changes, light sensitivity, hearing loss, and radiculopathy symptoms in the arms, such as tingling or numbness.
Spinal headaches are not usually serious and often resolve without treatment. However, they can be challenging to manage, especially if they occur after childbirth or alongside other medical issues. Treatment options include hydration to increase CSF pressure, and in more severe cases, an epidural blood patch (EBP) procedure. This involves injecting a small amount of the patient's blood into the epidural space to seal the leak. The prognosis for spinal headaches is generally good, with about 85% resolving without treatment and 60-70% of EBP procedures resulting in improvement within 24 hours.
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Temporary pain relief
Epidural steroid injections are a therapy option for chronic pain management. They are used to deliver corticosteroid medication into the epidural space of the spine, relieving pain from chronic or debilitating conditions. This space is where the bones and discs of the spine surround the nerves and spinal cord.
The injections are commonly used to treat back pain caused by a herniated disc, lumbar or cervical radiculopathy, spinal stenosis, or sciatica. They can also be used to treat cervical or thoracic herniated discs, radiculopathy, degenerative disc disease, or spinal stenosis. In the cervical region, these conditions cause pain and neuropathies that radiate to the arm and hand. In the thoracic region, pain can radiate to the ribs or flank.
The injections are generally safe and effective in providing pain relief, especially in the short to medium term. Research indicates a steroid injection success rate of 50% to 84%, depending on the condition being treated. The injections can provide reliable pain relief for up to six months in many cases. The steroids usually begin working within one to three days, although some people may need up to a week to feel the benefits.
However, there are risks and side effects associated with epidural steroid injections. The most common risk is that the injection does not provide meaningful pain relief. Other common side effects include mild injection site pain, temporary worsening of usual pain, flushing, insomnia, increased blood sugar, and headaches. These side effects are usually temporary and self-limited, resolving within one to three days.
More rarely, serious adverse events may occur, such as infection, haematoma, nerve damage, and in extremely rare cases, convulsions, serious infection, severe breathing difficulties, and even death. Permanent nerve damage can result from spinal cord damage or severe infection caused by the injection, leading to permanent loss of feeling or paralysis in the legs.
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Frequently asked questions
Epidural steroid injections are used to deliver corticosteroid medication into the epidural space around the spinal nerves to relieve chronic or debilitating pain.
While there is a risk of nerve damage and neurological symptoms, there is no specific mention of muscle spasms as a side effect of epidural steroid injections. Common side effects include headache, mild injection site pain, temporary worsening of pain, flushing, insomnia, and increased blood sugar.
Epidural steroid injections are a safe and effective way to manage severe or chronic back pain, with a success rate of 50% to 84%. They can provide quick and reliable pain relief for up to 6 months and help avoid more intensive pain relief procedures.
