Cortisone is the lay term for an injectable substance that has properties almost identical to the naturally occurring steroid produced by the adrenal glands within our bodies, typically activated during periods of intense stress, injury or inflammation.
To a large degree, corticosteroid injections are used primarily to treat moderate to severe inflammation, which includes arthritis, bursitis and tendinitis, and whose treatment is beyond the scope of oral medications, as well as other lesser treatment options like topical agents, ultrasound and therapy.
Destruction of Hyaline Cartilage
Our joints are covered by a smooth, resilient and plush type of cartilage called hyaline cartilage. It provides almost frictionless movement between two bone surfaces of a joint, as well as provide cushion to the weight-bearing joints.
Long-term usage of cortisone injections into a joint can result in the degradation and ultimate destruction of this cartilage, effectively worsening the very condition it was meant to treat.
Local Infection
Repeated needle punctures into the same area over time can greatly increase the risk of infection. Although the skin is properly prepped before the injection, there is always risk of inoculation of bacteria from the skin into the joint as the needle passes through the skin and subsequent layers.
Abcess Formation
Injections that are placed into areas such as bursae or tendon sheathes contribute to a risk of abscess formation if the cortisone is inadvertently deposited directly into soft tissues such as muscles or subcutaneous fat. The cortisone breaks down the cells of the muscle or fat and effectively kills the tissue, providing the medium for development of an infected abscess.
Poor Patient Selection
Not only can cortisone injections present a risk to different tissue types, poor selection of recipients can be equally treacherous. People who tend to be at the most risk for immuno-suppressant drugs, those that depress the body's natural defenses against infection, include diabetics, rheumatoid arthritis sufferers who are already on systemic doses of steroids for the disease and patients with severe vascular compromise in the lower extremities and whose overall circulation is compromised.
Nerve Damage
Nerve damage can be a substantial risk, especially during the administration of lumbar epidural steroid injections. In addition to the other, aforementioned risks, damage to nerve roots within the spinal sac and as they exit can occur from direct contact with the drug or other substances mixed with it such as local anesthetics. This can lead to scarring of the nerves, adhesion or scar band formation with considerable pain.
Lumbar epidural steroid injections are used as treatment options for severe, chronic back pain.
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