B23 Spinal injections in the treatment of spinal canal stenosis –Cons

<h3></h3> Spinal injections are a valuable tool in the management of spinal canal stenosis, providing significant pain relief, aiding in diagnosis, improving mobility, and potentially delaying or avoiding the need for surgery. The use of imaging guidance and proper technique are crucial to minimizing these risks. Careful patient selection and adherence to procedural guideline are important to avoid associated risks. Epidural steroid injections, while providing significant pain relief, their efficacy varies. They typically offer only temporary relief which translates to patients requiring multiple injections over time to maintain pain relief, which can be inconvenient and costly. Masking symptoms is another reason for questioning spinal injections in the basis of spinal stenosis. Many clinicians may support that they can lead to a delay in seeking more definitive treatments, such as physical therapy or surgery, which may be necessary for long-term improvement. The procedure itself involves risks associated with needle insertion near the spinal column. Side effects can include infection, bleeding, dural puncture, increased pain post-injection, allergic reactions and devastating nerve damage. Regarding the latter, the careful use of the steroid formulation is of utmost importance in order to avoid vessel infraction. Repeated use of steroid injections may cause increased blood sugar levels, osteoporosis, and weakening of the immune system. <h3>References</h3> Shin DA, Choo YJ, Chang MC. Spinal injections: a narrative review from a surgeon’s perspective. <i>Healthcare (Basel).</i> 2023;<b>11</b>(16):2355. doi:10.3390/healthcare11162355. Kennedy DJ, Huynh L, Wong J, Schramm E, Palmer W. Epidural steroid injections for lumbar spinal stenosis: a systematic review. <i>PMR.</i> 2015;<b>7</b>(10):1026-31. doi:10.1016/j.pmrj.2015.04.002. Bicket MC, Gupta A, Brown CH, Cohen SP. Epidural injections for spinal pain: a systematic review and meta-analysis evaluating the ‘control’ injections in randomized controlled trials. <i>Anesthesiology</i>. 2013;<b>119</b>(4):907-31. doi:10.1097/ALN.0b013e31829862d2. Buenaventura RM, Datta S, Abdi S, Smith HS. Systematic review of therapeutic lumbar transforaminal epidural steroid injections. <i>Pain Physician</i>. 2009;<b>12</b>(1):233-51. Kennedy DJ, Huynh L, Wong J, Schramm E, Palmer W. Epidural steroid injections for lumbar spinal stenosis: a systematic review. <i>PMR</i>. 2015;<b>7</b>(10):1026-31. doi:10.1016/j.pmrj.2015.04.002.