Influence of Epidural Steroid Injection on Adrenal Function

Area of Science:

• Endocrinology
• Neurosurgery
• Pain Management

Background:

• Spinal diseases often self-resolve, but epidural steroid injections (ESIs) are common treatments for spinal pain.
• Concerns exist regarding complications from repeated ESIs, yet their impact on adrenal function in spine surgery patients is understudied.
• This study investigates the effect of multiple preoperative ESIs on adrenal function in patients undergoing spine surgery.

Purpose of the Study:

• To assess the influence of multiple preoperative epidural steroid injections (ESIs) on adrenal function in patients undergoing spine surgery.
• To compare basal adrenal function and adrenal response to surgical stress between patients with and without a history of multiple ESIs.

Main Methods:

• Retrospective study with prospective data collection comparing spine surgery patients with multiple ESIs (study group) to knee arthroplasty patients without ESI history (control group).
• Preoperative and postoperative day one serum cortisol levels (SCL) were measured to assess basal adrenal function and response to surgical stress.
• Multivariate logistic regression analyzed risk factors for adrenal suppression, with patients categorized by normal (7-28 µg/dL) or subnormal SCL.

Main Results:

• The study group (n=53) had significantly lower preoperative SCL (10.4 ± 4.8 µg/dL) compared to the control group (n=130, 12.0 ± 4.2 µg/dL; p=0.026).
• The study group showed no significant increase in postoperative SCL (11.6 ± 5.0 µg/dL), indicating a blunted stress response (p=0.117).
• Spine surgery was an independent risk factor for adrenal suppression (OR, 3.472; p=0.015), regardless of age and sex.

Conclusions:

• Preoperative multiple epidural steroid injections may negatively influence adrenal function in patients undergoing spine surgery.
• Adrenal suppression should be a concern in spine surgery patients with a history of multiple ESIs.
• Further research is warranted to elucidate the mechanisms and clinical implications of ESI-induced adrenal suppression.