Interlaminar Lumbar Epidural Steroid Injections (IL LESI): Risks

The risks of interlaminar lumbar epidural steroid injection are generally low and manageable. Every effort is made to limit risk and mitigate side effects and complications when they do occur.

 

Interlaminar Lumbar Epidural Steroid Injections are one of the most common and safest procedures that we do. Risks fall into three general groups: rare complications, spinal headaches and drug reactions and side effects.

Rare complications included bleeding, infection, nerve damage, paralysis and even death. These complications occur somewhere in the range of 1:10,000 to 1:1,000,000. All spinal injections at Schlesinger Pain Centers are done under local anesthesia, with image guidance (fluoroscopy in virtually all instances and ultrasound for pregnant woman), which greatly enhances their safety. All patients are given extensive follow up instructions and told to call in at the first sign of trouble, so that potential complications can be treated, averted or mitigated.

Any time a needle is placed near the spine there is a risk of dural puncture and post-spinal headaches. These headaches occur with a frequency of 1-2% and can be severe, lasting for up to 2 weeks. We currently use primarily 22 and 25 gauge needles for most spinal work. With these tiny needles our rate of spinal headaches is less than 1% and when they occur the headaches rarely last for more than 1-2 days.

Drug reactions and side effects fall into 4 groups: allergic reactions, irritative reactions to steroid preparations and acute and chronic steroid side effects. Allergic reactions occur most commonly in response to iodinated X Ray contrast media and are extremely rare due to the very small amount of dye used. When they occur they are usually treated with small doses of Benadryl although a complete crash cart with resuscitation drugs and equipment is always on hand. Irritative reactions to steroid preparations (or flair reactions as I like to call them) occur in 10-20% of cases. Most of these reactions are mild.

The most common acute steroid side effects include a change in mood, a change in appetite and a change in sleep pattern and predictably occur in 3-5% of patients. These changes will last from 3 days to one week depending on the steroid preparation used.

Chronic steroid side effects are a major factor limiting the use of epidural steroid injections. These side effects can be quite severe, but should not occur, provided you are honest with all of your doctors. Three short term exposures to steroids in a 6 month period are generally thought to be safe for relieving chronic pain, but that means three total, not three from me and three from your orthopedic surgeon and three from your dermatologist.

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