Clinical StudyThe effect of preoperative lumbar epidural corticosteroid injection on postoperative infection rate in patients undergoing single-level lumbar decompression
Introduction
Lumbar epidural corticosteroid injections (LECIs) are frequently used in the treatment of lumbar intervertebral disc herniation with radiculopathy and lumbar spinal stenosis [1], [2], [3], [4]. They are often used as a temporizing measure to relieve radicular pain before surgery, as a diagnostic and prognostic adjunct, and in some cases as a definitive treatment [5], [6], [7], [8]. Although widely used, their effect on the outcomes of subsequent surgery is unclear [1], [2], [3]. Postoperative infection can be a morbid complication following spine surgery, and recent literature has suggested that the risk may be increased in patients undergoing lumbar spinal surgery who had previously received LECIs [9], [10]. Another recent series, however, found no significant association between injections and postoperative infection after surgery for degenerative lumbar spine disease [11].
Despite several recent articles, overall there is a paucity of evidence in the spine literature examining this topic. Furthermore, with the available literature, there is a lack of consensus on the effects of LECIs on postoperative infection. We sought to characterize the overall postoperative infection rate in patients undergoing lumbar spine decompression surgery in the Military Health System (MHS) patient population and examine the effects of LECIs on postoperative infections. Based on reports from spine and total joint arthroplasty literature [9], [10], [12], [13], we hypothesized that the postoperative infection rate would be increased in patients who had received preoperative LECIs in the MHS and that this effect would be more pronounced the shorter the interval between the LECIs and surgery.
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Methods
The Military Health System Data Repository contains comprehensive data on all health care provided or paid for by the MHS to active duty servicemembers, retirees, and their dependents. Following approval by our local Institutional Review Board, the Military Health System Management Analysis and Reporting Tool (M2) was used to search the Military Health System Data Repository for all patients who had undergone lumbar spine surgery from 2009 to 2014 and refined using Current Procedural
Results
The search identified 6,535 patients who had undergone single-level lumbar decompression surgery from 2009 to 2014 within the MHS. Of these, 847 patients had received at least one LECI before surgery: 167 patients received LECIs within 30 days of surgery, 318 patients between 31 and 90 days, 202 patients between 91 and 180 days, 89 patients between 181 and 365 days, and 71 patients greater than 365 days before surgery. Our control group consisted of the remaining 5,688 patients who had
Discussion
The overall postoperative infection rate for all patients in the MHS undergoing lumbar decompressive surgery was 0.81%, and the postoperative infection rate for patients in our control population was 0.76%. Postoperative infection rates in the various subgroups of patients receiving preoperative LECIs ranged from 0% to 1.57%, with an overall postoperative infection rate of 1.18% for all patients receiving injections. These rates are comparable with the postoperative infection rates of 0.8%–1.7%
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Cited by (0)
FDA device/drug status: Not approved for this indication (epidural steroid injection).
Author disclosures: JGS: Nothing to disclose. GCB: Nothing to disclose. TS: Nothing to disclose. MH: Nothing to disclose. DEG: Nothing to disclose. SCW: Nothing to disclose.
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army/Navy/Airforce, Department of Defense, or U.S. Government.