Epidural Steroid Injection Safety and Efficacy

Dosing Considerations

Secondary adrenal insufficiency from 80 mg methylprednisolone can persist for up to 4 weeks, and in a small proportion of patients up to 2 months 1
Dexamethasone and betamethasone produce shorter duration of immune suppression compared to methylprednisolone 1

Avoid particulate steroids (methylprednisolone, triamcinolone) for cervical transforaminal injections due to risk of catastrophic neurological injury 1
Use only non-particulate steroids (dexamethasone, betamethasone) for cervical transforaminal approaches 1
During the COVID-19 pandemic or in immunocompromised patients, consider that steroid injections increase infection risk, particularly with depot methylprednisolone 1
Intra-articular corticosteroid injections are associated with higher risk of influenza infection 1

Increasing cumulative corticosteroid dose carries risk of secondary adrenal insufficiency, immunosuppression, and increased infection risk 1