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Preoperative epidural steroid injections are not associated with increased rates of infection and dural tear in lumbar spine surgery

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Abstract

Purpose

The study objectives were to use a large national claims data resource to examine rates of preoperative epidural steroid injections (ESI) in lumbar spine surgery and determine whether preoperative ESI or the timing of preoperative ESI is associated with rates of postoperative complications and reoperations.

Methods

A retrospective longitudinal analysis of patients undergoing lumbar spine surgery for disc herniation and/or spinal stenosis was undertaken using the MarketScan® databases from 2007–2015. Propensity-score matched cohorts were constructed to compare rates of complications and reoperations in patients with and without preoperative ESI.

Results

Within the year prior to surgery, 120,898 (46.4%) patients had a lumber ESI. The median time between ESI and surgery was 10 weeks. 23.1% of patients having preoperative ESI had more than one level injected, and 66.5% had more than one preoperative ESI treatment. Patients with chronic pain were considerably more likely to have an ESI prior to their surgery [OR 1.62 (1.54, 1.69), p < 0.001]. Patients having preoperative ESI within in close proximity to surgery did not have increased rates of infection, dural tear, neurological complications, or surgical complications; however, they did experience higher rates of reoperations and readmissions than those with no preoperative ESI (p < 0.001).

Conclusion

Half of patients undergoing lumbar spine surgery for stenosis and/or herniation had a preoperative ESI. These were not associated with an increased risk for postoperative complications, even when the ESI was given in close proximity to surgery. Patients with preoperative ESI were more likely to have readmissions and reoperations following surgery.

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Code availability

The code used for analysis during the current study is available from the corresponding author on reasonable request.

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Funding

Data for this project were accessed using the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and from Internal Stanford funding. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Stanford University School of Medicine, 450 Broadway Street, Pavilion C, 4th Floor, Mail Code 6342, Redwood City, CA, 94063, USA

    Jayme C. B. Koltsov, Matthew W. Smuck, Todd F. Alamin, Kirkham B. Wood, Ivan Cheng & Serena S. Hu

Authors
  1. Jayme C. B. Koltsov
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  2. Matthew W. Smuck
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  3. Todd F. Alamin
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  4. Kirkham B. Wood
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  5. Ivan Cheng
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  6. Serena S. Hu
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Contributions

All authors contributed to the conception and design, interpretation of the data, and critical revision of the manuscript for intellectual content. JK was additionally responsible for the acquisition of the data, data analysis, and drafting of the manuscript. All authors approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jayme C. B. Koltsov.

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Availability of data and material

The datasets analyzed during the current study are not publicly available, as access to the IBM® MarketScan® databases requires a data use agreement and the data are not freely available.

Conflicts of interest

The authors have the following unrelated disclosures: JK: co-investigator on grants from the National Institutes of Health (National Institute of Arthritis and Musculoskeletal and Skin Diseases), North American Spine Society, and Orthopaedic Research and Education Foundation; MS: stock ownership in Bluejay Mobile Health and NuSpine, private investments in Vivametrica, consulting for State Farm and Spine Biopharma, travel funds from Spine Intervention Society, board of directors for Spine Intervention Society, scientific advisory board for Bluejay Mobile Health and NuSpine, principal investigator on grants from Relievant Medsystems and Rewalk; TA: private investments in Empirical Spine and Disc Diagnostics, consulting for Medtronic, Depuy, and Empirical Spine, speaking arrangement for Globus, board of directors for Empirical Spine, fellowship support from Omega; KW: royalties from Globus Spine, scientific advisory board for LifeSpine and Kuyucera; IC: royalties from Nuvasive, SpineWave, and SpineCraft, stock ownership in Nuvasive, private investments in Cytonics, Spine Innovations, and SpinalCyte, consulting for Stryker Spine and Nuvasive, scientific advisory board for Notogen, and research support from Limiflex; SH: Royalties and stock ownership in Nuvasive, principal investigator on a grant from the North American Spine Society.

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Koltsov, J.C.B., Smuck, M.W., Alamin, T.F. et al. Preoperative epidural steroid injections are not associated with increased rates of infection and dural tear in lumbar spine surgery. Eur Spine J 30, 870–877 (2021). https://doi.org/10.1007/s00586-020-06566-6

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  • DOI: https://doi.org/10.1007/s00586-020-06566-6

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