The Impact of Preoperative Spinal Injection Timing on Postoperative Complications of Lumbar Decompression Surgery

Syed I Khalid; Pranav Mirpuri; Elie Massaad; Kyle B Thomson; Ali Kiapour; John H Shin; Owoicho Adogwa

doi:10.1227/neu.0000000000002857

The Impact of Preoperative Spinal Injection Timing on Postoperative Complications of Lumbar Decompression Surgery

Neurosurgery. 2024 Feb 20. doi: 10.1227/neu.0000000000002857. Online ahead of print.

Authors

Syed I Khalid^{1

2}, Pranav Mirpuri³, Elie Massaad², Kyle B Thomson³, Ali Kiapour², John H Shin², Owoicho Adogwa⁴

Affiliations

¹ Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
² Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
³ Chicago Medical School, North Chicago, Illinois, USA.
⁴ Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA.

PMID: 38376173
DOI: 10.1227/neu.0000000000002857

Abstract

Background and objectives: Epidural steroid injections (ESIs) are commonly used for lower back pain management. The effect of these injections on lumbar decompression surgery outcomes is hitherto underexplored. The study objective was to determine the impact of ESIs on postoperative rates of medical and surgical complications and to define the appropriate interval before lumbar decompression surgery.

Methods: This retrospective all-payer database analysis identified 587 651 adult patients undergoing one- to three-level laminectomies from January 2010 to October 2021. A 2:1 propensity score match accounting for comorbidities, levels of surgery, and demographics was performed to create two cohorts: (1) 43 674 patients who had received an ESI in the 90 days before laminectomy and (2) 87 348 patients who had not received an ESI. The primary outcome was the rates of medical and surgical complications between groups at 30 days postoperatively. Patients were divided into five cohorts based on injection time before surgery: 1 to 30 days, 31 to 45 days, 46 to 60 days, 61 to 75 days, and 76 to 90 days. Logistic regression was performed between groups to identify temporal associations of complication rates. Confidence intervals of 95% are provided when appropriate. P values < .01 were considered significant.

Results: Rates of medical complications within 30 days of surgery were significantly higher in those with ESI compared with control (4.83% vs 3.9%, P < .001). Cerebrospinal fluid (CSF) leak rates were increased in the ESI group at 0.28% vs 0.1% (P < .001), but surgical site infection rates were not significantly different between groups (1.31% vs 1.42% P = .11). ESI performed within 30 days was associated with increased odds of CSF leak (OR: 5.32, 95% CI: 3.96-7.15).

Conclusion: Preoperative ESI increases the risk of CSF leak and medical complications after lumbar decompression. Because these complications were significantly associated with ESIs given 1 to 30 days before surgery, avoiding ESIs at least 30 days before surgery may be advisable.