In the midst of the COVID-19 pandemic, IBJI, like other medical/hospital systems, is taking extraordinary measures to ensure the safety of our patients.  As of March 16^th, CDC guidance directs the health system to, “reschedule non-urgent outpatient visits as necessary.”  This is an ever-changing landscape and Dr. Garala will continue to keep you abreast with the most up-to-date recommendations which can change at any moment.

When considering a procedure for a patient with known COVID-19 infection, suspected COVID-19 infection, or a patient who has had close contact with an infected individual, non-urgent interventional pain procedures should be postponed until the patient is no longer infectious or it is determined they do not have COVID-19.

Otherwise, physicians are being asked to carefully consider when to cancel non-urgent procedures, such as spinal injections, to reduce the potential risk of infection.  Although there exists no specific data on immune system effects from epidural administration of glucocorticoids, data is available regarding systemic administration (oral steroid: 40 mg or more of prednisone per day) showing there is an immediate risk of infection.  While there have been numerous case reports of infections after epidural steroid injections (ESI), none have causally linked the infections to an immunosuppressed state in the described patients.  Most of these infections were attributable to contaminated injectates or poor infection control practices.  Overall, the incidence of infections associated with spine procedures remains exceedingly low.  However, immunosuppressed patients (elderly, diabetics, people with heart disease, on immunosuppressive medications, those who have chronic lung or kidney disease) could be considered at increased risk for infections.  That is why there is concern of performing the spinal injections given the predilection of COVID-19 for older patients with certain medical conditions.

Spinal injections are considered elective procedures that are used to treat pain.  If your pain is improving or currently tolerable, consideration should be made to reschedule the injection for a later date.  However, if your pain is severe and functionally limiting, as long as you understand the current risks of the procedure, it could be decided to keep your scheduled injection.

Please notify Dr. Garala or his team if you have any questions.