The Spine Intervention Society is currently developing recommendations about timing of corticosteroid injections prior to and after COVID-19 vaccination. It is anticipated that these recommendations will be published and shared with SIS members in early February.
In order to provide some guidance in the interim, we are sharing current preliminary recommendations, which are subject to change:
- TIMING OF INJECTIONS PRIOR TO COVID-19 VACCINATION (NOT BRAND-SPECIFIC):
It may be prudent, based on indirect evidence, to schedule elective corticosteroid injection approximately two weeks before vaccine administration and no later than one week before vaccine administration to avoid potential decrease in immunogenicity of the mRNA vaccines.
- TIMING OF INJECTIONS AFTER COVID-19 VACCINATION (BRAND-SPECIFIC):
- Pfizer-BioNTech COVID-19 mRNA Vaccine — Theoretically, it is unlikely for a corticosteroid injection to diminish the immunogenicity expected to be achieved by around day 28 or seven days after dose 2, and we would recommend proceeding with corticosteroid injections after this point in time.
- Moderna COVID-19 mRNA Vaccine — Based on the data that are provided in two-week intervals, we would recommend timing corticosteroid injections at around day 42 or 14 days after dose 2.
There is no direct evidence that corticosteroid injection renders the vaccine ineffective. Given potentially unique circumstances related to each individual patient, including COVID-19 risk factors, potential morbidity/mortality from the illness, and the nature of indications for the corticosteroid injection, an injection may be appropriate inside of the optimal waiting periods. Physicians should discuss the risks and benefits with their patients and involve them in the shared decision-making process.