Preoperative Epidural Steroid Injections and Postoperative Infections After Lumbar or Cervical Spine Surgery: A...

Area of Science:

• Spine Surgery
• Anesthesiology
• Infectious Disease

Background:

• Preoperative epidural steroid injections (ESIs) are common before spine surgery.
• The association between ESIs and postoperative infections (POIs) requires clarification.
• Understanding this risk is crucial for patient safety and surgical planning.

Purpose of the Study:

• To determine the risk difference and 95% prediction intervals (PIs) for POIs.
• To assess the impact of preoperative ESIs on POI risk in adults undergoing lumbar or cervical spine surgery.

Main Methods:

• Systematic review and meta-analysis of 12 studies (9 in meta-analysis).
• Searches conducted through December 2023, including all study designs.
• Risk of bias assessed using a modified tool for uncontrolled studies.

Main Results:

• Preoperative ESIs within 1 month of lumbar surgery increased POI risk by 0.6% (decompression) and 2.31% (fusion).
• In adults ≥65, ESIs within 1-3 months of lumbar surgery showed a 1.3% and 0.6% increased POI risk.
• No increased POI risk was observed for ESIs within 3 months of cervical spine fusion.

Conclusions:

• Preoperative ESIs are associated with a small, generally nonsignificant, increased risk of POIs after lumbar spine surgery.
• ESIs before cervical spine fusion do not appear to increase POI risk.
• Findings support shared decision-making regarding ESI use prior to spine surgery.