Lee Min Soo, Moon Ho Sik
Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Anesth Pain Med (Seoul). 2021 Jan;16(1):16-27. doi: 10.17085/apm.21002. Epub 2021 Jan 27.
Spine disease is one of the most common musculoskeletal diseases, especially in an aging society. An epidural steroid injection (ESI) is a highly effective treatment that can be used to bridge the gap between physical therapy and surgery. Recently, it has been increasingly used clinically. The purpose of this article is to review the complications of corticosteroids administered epidurally. Common complications include: hypothalamic-pituitary-adrenal (HPA) axis suppression, adrenal insufficiency, iatrogenic Cushing's syndrome, hyperglycemia, osteoporosis, and immunological or infectious diseases. Other less common complications include psychiatric problems and ocular ailments. However, the incidence of complications related to epidural steroids is not high, and most of them are not serious. The use of nonparticulate steroids is recommended to minimize the complications associated with epidural steroids. The appropriate interval and dosage of ESI are disputed. We recommend that the selection of appropriate ESI protocol should be based on the suppression of HPA axis, which reflects the systemic absorption of the corticosteroid.
脊柱疾病是最常见的肌肉骨骼疾病之一，在老龄化社会中尤为如此。硬膜外类固醇注射（ESI）是一种高效的治疗方法，可用于弥合物理治疗与手术之间的差距。近年来，它在临床上的应用越来越广泛。本文旨在综述硬膜外给予皮质类固醇的并发症。常见并发症包括：下丘脑-垂体-肾上腺（HPA）轴抑制、肾上腺功能不全、医源性库欣综合征、高血糖、骨质疏松以及免疫或感染性疾病。其他不太常见的并发症包括精神问题和眼部疾病。然而，与硬膜外类固醇相关的并发症发生率并不高，且大多数并不严重。建议使用非颗粒性类固醇以尽量减少与硬膜外类固醇相关的并发症。ESI的合适间隔时间和剂量存在争议。我们建议，应根据反映皮质类固醇全身吸收情况的HPA轴抑制情况来选择合适的ESI方案。
