What are the contraindications for epidural steroid injections (ESIs)?

Updated: Aug 06, 2018
  • Author: Boqing Chen, MD, PhD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Absolute contraindications for ESIs include the following:

  • Systemic infection or local infection at the site of a planned injection

  • Bleeding disorder or fully anticoagulated (eg, on a fully therapeutic dose of warfarin, heparin, or other anticoagulant)

  • History of significant allergic reactions to injected solutions (eg, contrast, anesthetic, corticosteroid)

  • Acute spinal cord compression

  • Patient refusal to proceed with the injection procedure

In addition, fluoroscopy should not be used in epidural injections for women who are pregnant, to avoid exposing the fetus to ionizing radiation. Caution should be used when performing injections in patients with poorly controlled diabetes, since the corticosteroid may transiently, but significantly, increase blood glucose levels. Patients with a history of immunosuppression may require additional precautions, such as preprocedure laboratory testing and/or antibiotics. Caution should be exercised when performing injections in individuals who have a history of congestive heart failure because of the potential for steroid-induced fluid retention.

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