Effect of Preoperative Epidural Spinal Injections on Complications After Posterior Lumbar Interbody Fusion

Study DesignRetrospective Cohort study.ObjectiveTo examine whether preoperative epidural spinal injections (ESI) is associated with postoperative infection, dural leak, or nerve injury following posterior lumbar interbody fusion (PLIF).MethodsThe PearlDiver database was used to identify adults aged 18-85 who underwent a PLIF procedure between 2016 and 2022. Only patients that received an ESI up to three years prior to the PLIF were included. Complications were excluded if they occurred more than 120 days after PLIF. Chi-squared tests were performed for statistical analyses on the entire cohort pooled across years.ResultsA total of 172,422 patients met inclusion criteria, of which 9,740 (5.6%) received a preoperative ESI. The incidence of postoperative infection was significantly higher in the overall injection cohort compared with patients without prior injection (OR 1.38, 95% CI 1.22-1.53, p < 0.0001). When stratified by timing, ESIs administered within 3 years (OR: 1.29, p = 0.003), 1 year (OR: 1.37, p = 0.027), 6 months (OR: 1.48, p = 0.016), and 6 weeks (OR: 1.62, p = 0.029) before surgery were each associated with higher postoperative infection risk. No statistically significant differences were observed in dural leak incidence between injection and no-injection patients (p = 0.83). Pre-operative ESI was associated with greater odds of nerve injury (OR: 1.75, p =0.047).ConclusionPLIF performed after ESI is associated with modestly increased risk of infection and nerve injury. Shorter time from ESI to PLIF is associated with higher rates of infection.