The transcription below was taken from videos posted at SpineCenterofTexas.com
This is Dr. Sahni with Spine Center of Texas. And I would like to very briefly and generally talk to you about different types of steroids. There are many different types of steroids that we can inject into your knee, your shoulder, and of course, into your spine and even into your muscles. When we do trigger point injections, the two basic types of steroids I’d like to talk about are Particulate and Non Particulate steroids. Particulate steroids are those that tend to have a white color, a creamy color, and they have crystals inside. Some people would argue that these crystals tend to hold the steroid inside the joint for longer periods of time and can make the steroid more effective. And this very well may be the case, but when you’re using a Particulate steroid in and around the spine, there is a very real and described danger in the medical literature.
So, an example of a Particulate steroid that we use in our office is Depo-Medrol again, it has sort of a white milky color Depo-Medrol is very commonly injected into joints all over the body and even into Carpal Tunnel people with Carpal Tunnel inflammation, people with tendon inflammation, people with muscular inflammation in trigger point injections. And I think the Depo-Medrol is an excellent choice for these applications because the risk of the Particulate steroid affecting nerves or the spinal cord is essentially zero. However, in the spine, there are two types of medications that we typically use in our office. Typically, we use Dexamethasone, or in some cases, people will use Betamethasone. Dexamethasone is a Non Particulate steroid. What does that mean? That means that it’s a clear liquid. If you were to look at Dexamethasone, it essentially looks like water, and there really isn’t any conclusive studies that show that Particulate steroid like Depo-Medrol is any more effective in treating spine issues than Dexamethasone.
However, there is literature showing that these little particles or crystals that are inside the Particulate steroid can clump together kind of like platelets do when they can cause a heart attack or a stroke. And so when you’re injecting these around the spine, if you inadvertently enter these Particulate steroid into a small artery, these little particles or Particulate steroid particles can clump and actually cause a mini stroke in the spinal cord, there have been, although extremely rare, there have been some cases of people becoming paraplegic and even quadriplegic after being injected with Particulate steroid. Although this is a very small number, it does exist in the literature and to this date, after having millions and millions of injections across the country, there has never been a case of a Non Particulate steroid. Like Dexamethasone the one that we use in our office ever any of these types of problems.
Because again, there are no particles to clunk. It’s a pure liquid and will just flow through the vessel like any other liquid and has no opportunity to occlude or stroke out your spinal cord. In conclusion, we use what we believe to be the safest technique possible. Anytime we have a risk of injecting Particulate steroid and having it affect your spinal cord, we simply don’t use Particulate steroid in the cases where we’re injecting joints, bursa, and areas where this is just not likely to happen or nearly impossible to happen. Then we will often use Depo-Medrol the longer-lasting and potentially more effective type of steroid.