Steroid Use & Spine Red Flags

Systemic Steroids

Common indications

• Autoimmune flare (e.g., RA, PMR), severe asthma/COPD exacerbation.
• Short course for acute radiculopathy is controversial; if used, limit duration and dose.

Avoid / caution

• Active infection (esp. TB, fungal), uncontrolled diabetes, severe osteoporosis, peptic ulcer with GI bleed history.
• Consider PPI, glucose monitoring, bone protection when prolonged.

Example short taper

Prednisone 40 mg daily x3–5 days → 30 mg x3d → 20 mg x3d → 10 mg x3d → stop (tailor to case).

Epidural / Injection

• Indicated for radicular pain with imaging concordance; avoid if progressive deficit or infection.
• Do not repeat frequently; typical interval > 2–3 months, limit total per year.
• Check diabetes control; warn about transient glucose spikes.

Absolute contraindications: coagulopathy without correction, local/systemic infection, patient refusal.

Neurologic Emergencies

• Cauda equina signs: bowel/bladder change, saddle anesthesia, rapidly progressive weakness.
• Acute cord compression: bilateral weakness, spasticity, sensory level.
• Spinal epidural abscess: fever + back pain + neuro deficit; MRI and urgent consult.

Action: urgent MRI, surgical/ED referral; do not mask with steroids unless directed by specialist.

Bone & Metabolic Protection

• Calcium/Vit D, consider bisphosphonate if long-term systemic steroids (≥2.5–5 mg pred eq for ≥3 months).
• Monitor BP, glucose, weight; vaccinate (influenza, pneumococcal) as appropriate.
• Screen for TB/hepatitis risk before biologics or prolonged immunosuppression.