Letters
Neurology
Volume 199 - Issue 11

Time to reconsider steroid injections in the spine?

Author:  Nikolai Bogduk

Med J Aust 2013; 199 (11): 752. || doi: 10.5694/mja13.11077
Published online: 16 December 2013
To the Editor: In their review, Harris and Buchbinder call for a ban on all spinal injections of steroids.1 These injections are not a singular procedure; they differ by indications, technique, and the evidence that serves each. For the treatment of low back pain, no evidence supports the use of epidural steroids, and intra-articular injections of steroids are clearly no more effective than sham therapy.2 Disavowing ...
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To the Editor: In their review, Harris and Buchbinder call for a ban on all spinal injections of steroids.1 These injections are not a singular procedure; they differ by indications, technique, and the evidence that serves each.

For the treatment of low back pain, no evidence supports the use of epidural steroids, and intra-articular injections of steroids are clearly no more effective than sham therapy.2 Disavowing this treatment is, therefore, justified. Ironically, the treatment with the greatest success rate and longest duration of success for chronic low back pain is injection of normal saline.3

For the treatment of radicular pain, multiple studies have shown that epidural injections of steroids are no more effective than sham treatment.4,5 One study showed marginal superiority over placebo at 3 weeks,6 but by 30 days, the number needed to treat is 100.7 Yet, the Faculty of Pain Medicine still endorses this intervention.8

The evidence is different for transforaminal (TF) injection of steroids. The success rate of TF injection of steroids is significantly greater than that of TF injection of bupivacaine or saline, or intramuscular injection of steroids or saline.9 Furthermore, TF steroid therapy has a surgery-sparing effect and is cost-effective.10 A blanket ban on steroid injections would deny patients with radicular pain the only proven alternative to surgery.

The baby’s bathwater is distinctly polluted, but within it is a gem. Before throwing it out, the water needs to be carefully filtered.

Author

  • Nikolai Bogduk1
  • 1. Newcastle Bone and Joint Institute, Newcastle, NSW.

Correspondence: nbogduk@bigpond.net.au

Competing interests

I am a Board member of the International Spine Intervention Society; while I am an exponent of the procedures in question, I derive no income from them.

References

View this article on Wiley Online Library

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