Epidural Corticosteroids Receive FDA Warning
Just days after we went to press with Dr. Deborah Pate's review of epidural corticosteroid injections for sciatica (May 15 issue), which concluded, based on the available evidence, that epidural steroid injections "have little clinical benefit (short or long term), and are associated with significant risks ... cause deterioration of bone quality, elevating the risk of spinal fracture ... and have increase dramatically [in terms of use] despite lack of evidence to justify the procedure," the Food & Drug Administration has issued a warning regarding their use that specifies even more severe potential consequences.
According to the FDA in its April 23, 2014 announcement:
"Injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death. The injections are given to treat neck and back pain, and radiating pain in the arms and legs. The effectiveness and safety of epidural administration of corticosteroids have not been established, and FDA has not approved corticosteroids for this use."
The FDA is requiring that drug labels of injectable corticosteroids carry a warning detailing these potential risks, and recommends that patients "discuss the benefits and risks of epidural corticosteroid injections with their health care professionals, along with the benefits and risks associated with other possible treatments."
The administration also announced plans to convene a meeting of "external experts" later this year to discuss the benefits vs. risks of epidural corticosteroid injections. The advisory committee meeting could lead to further FDA actions.
A DC at the White House
William Morgan, DC, team chiropractor for the United States Naval Academy's football team, joined the team in Washington, D.C., on April 18, 2014 as President Obama presented the team with the coveted Commander-in-Chief Trophy, awarded to the service academy that defeats the other two military academy football teams. During the 2013 season, Navy beat Air Force 28-10 and Army 34-7.
"Working with these scholar athletes is a unique and stimulating experience," said Dr. Morgan, "and every Navy football player turns pro when they graduate. They all become professional officers and leaders in the United States Navy or Marine Corps."
Commenting on Dr. Morgan's affiliation with the team, a role he has held for the past five seasons, team orthopedic surgeon Dr. John Wilckens stated:
"Much of the success in recent years of our football team amidst the stiffening competition has been the conditioning and coaching of our recruited athletes. As our kids become stronger and faster ... they need constant tweaking and adjusting (excuse the pun). Dr. Morgan has been a valuable resource, sorting out much of the low back pain that accompanies collision sports, at the same time preserving our athletes' career aspirations in the military."
Erratum
Dr. Arthur Croft's "Revisiting the Neurological Exam" (published in the May 1, 2014 DC) included three figures with captions. Unfortunately, while the captions were correctly placed in the article and referenced the correct figures, the figures appeared out of order and thus conflicted with the captions.
The first figure should have accompanied the second caption, as it illustrates the standard dermatome map of sensory innervation. The second figure should have accompanied the third caption, as it illustrates a segmental map of referred pain and paresthesia produced by irritation of paraspinal tissues. The third figure should have accompanied the first caption, as it illustrates the human nervous system and in particular, the important nerve roots emanating from the spine.
We apologize for this oversight and any confusion it may have caused readers of the article in either the print or app formats. The online version of the article has been corrected.
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