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medications
Steroid Dosing for Spine Procedures
| Steroid | Type | Typical Dose | Max Single Dose | Best For | Key Safety Note |
|---|---|---|---|---|---|
| Dexamethasone (Decadron) | Non-particulate | 4-10 mg | 10 mg | Cervical TFESI (mandatory), all TFESI | MANDATORY for cervical TFESI. Particles smaller than RBCs — no embolic risk. |
| Triamcinolone (Kenalog) | Particulate | 40-80 mg | 80 mg | Interlaminar, caudal, facet injections | NEVER for cervical TFESI. Particle aggregation can cause spinal cord infarction. |
| Methylprednisolone (Depo-Medrol) | Particulate | 40-80 mg | 80 mg | Interlaminar, joint injections | Largest particle size of common steroids. Higher aggregation risk than triamcinolone. |
| Betamethasone (Celestone) | Particulate | 6-12 mg | 12 mg | Joint injections, some epidurals | Smaller particles than triamcinolone/methylprednisolone. Less aggregation but still particulate. |
Notes
- 1. Max 4 epidural steroid injections per 12-month period (HPA axis suppression, bone density)
- 2. Allow minimum 2-week interval between injections for HPA axis recovery
- 3. Annual cumulative dose cap: approximately 200 mg methylprednisolone equivalent
- 4. Dexamethasone is non-inferior to particulate steroids for lumbar TFESI at short-term follow-up (Kennedy 2014)
- 5. Ropivacaine precipitates when mixed with dexamethasone — use lidocaine or bupivacaine instead
Source: IPSIS Technical Manual, UpToDate, SIS Guidelines | Updated: 2026-04-03
Printed from Interventional Pain Trainer | Steroid Dosing for Spine Procedures | 2026-04-03