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Preoperative Epidural Steroid Injections and Surgical Site Infection Risk in Lumbar Spine Surgery: A Retrospective
Muhammad Waheed1, Brandon Henry2, Abdurrahman Ehsan3
1Orthopaedic Surgery, Detroit Medical Center Wayne State University, Detroit, USA.
Cureus
|June 27, 2025
Summary
The timing of preoperative epidural steroid injections (ESIs) does not impact surgical site infection (SSI) risk in lumbar spine surgery. Focus on modifiable factors like BMI, DMARDs, and ASA scores to mitigate infection risk.
Area of Science:
- Orthopedics
- Neurosurgery
- Infectious Disease
Background:
- Low back pain is a significant cause of global work-related disability.
- Epidural steroid injections (ESIs) are common nonoperative treatments for lumbar spine pathology.
- Understanding the impact of preoperative ESIs on surgical outcomes is crucial.
Purpose of the Study:
- To evaluate the association between the timing of preoperative ESIs and the incidence of surgical site infections (SSIs).
- To identify potential risk factors for SSIs in patients undergoing lumbar spine surgery.
Main Methods:
- Retrospective analysis of 94 patients undergoing lumbar spine surgery (January 2020 - December 2021).
- Patients categorized into: no ESI, early ESI (within 3 months preoperatively), and late ESI (≥3 months preoperatively).
- Statistical analyses included Spearman's rank correlation and chi-square tests to assess risk factors and infection rates.
Main Results:
- Overall SSI rate was 2.2% (one infection in each ESI subgroup).
- No significant difference in SSI rates between early and late ESI groups (p=0.171).
- Higher BMI, Disease-Modifying Antirheumatic Drug (DMARD) use, and American Society of Anesthesiologists (ASA) scores were associated with increased SSI risk (p<0.05).
Conclusions:
- Preoperative ESI timing does not significantly affect SSI risk in lumbar spine surgery.
- Elevated BMI, DMARD use, and higher ASA scores are identified as potential SSI risk factors.
- Infection risk mitigation should prioritize modifiable factors over ESI timing.
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