The complications of ill-advised epidural steroid injection represent one of the most serious, and under appreciated, public health problems in the United States today. Because many in the medical community have not learned the lesson adhesive arachnoiditis continues to be caused in unsuspecting patients by physicians who aren’t doing the “right thing” for their patients (because they don’t know what it is). At the present time the only “safety-net” for the patient is legal recourse and epidural steroid medical malpractice cases are increasing in incidence throughout the country. This is a shameful situation. Contributing to epidemic of adhesive arachnoiditis cases is poor information being circulated to the public by those who possess their trust.
If patients do not routinely survey the published medical literature, they must depend on other sources for information. As demonstrated here even publications specifically developed for patient handout education can be woefully misleading.
Shown above is the most frequently distributed “patient’s guide” on “Lumbar Epidural Injections” originally published in 1998. Note that under “Risks and Complication” there is no mention of the most serious complication…that of adhesive arachnoiditis!
From this pamphlet the unsuspecting patient might be led to the incorrect belief that the use of all steroid preparations is associated only with minor or rare problems. Even more astonishing is the following comprehensive review Epidural Steroids published by the prestigious North American Spine Society Review, also failing to even mention adhesive arachnoiditis as a matter of concern:
Checklist To Follow Before Ever Having A Epidural Steroid Injection
- Become familiar with the subject.
- Seek a specific diagnosis before ever entering into any form of invasive
“There is no non-specific back pain, but there are non-specific doctors.
- Find out if alternative non-invasive therapies are available.
- If ESI is recommended determine the type of technique being used and the specific steroid being used.
- Be particularly circumspect if an anesthesiologist is the procedurist.
Some procedurists and lawyers have attempted to defend the practice of “blind” epidural steroid injection with glycol-containing steroids as being a “Standard of Care” in the community. While this practice may, unfortunately, be “common” among some procedurists it is not common among their more enlightened colleagues. A “Standard of Care” can never be something known to be injurious to the patient. Ignorance of consequences is not an excuse for failure to obtain true informed consent.