Our Summary

This research paper examines whether there is an increased risk of infection after back surgery for patients who have had epidural steroid injections (ESI) prior to their operation. The researchers analyzed data from various studies in a process called a meta-analysis. They compared infection rates in patients who had ESI within 30 days of surgery, patients who had ESI between 1 and 3 months before surgery, and patients who had any history of ESI.

Out of nine studies included in their analysis, five found a link between ESI and postoperative infection, while four found no such link. However, when they looked at the average infection rates, there was no significant difference between the groups.

In simpler terms, the researchers found no evidence to suggest that having an epidural steroid injection before back surgery increases the risk of infection after the surgery. Therefore, they conclude that back surgery should not be delayed because of preoperative steroid injections. However, they also highlight that more high-quality research is needed on this topic.

FAQs

  1. Does having an epidural steroid injection before back surgery increase the risk of postoperative infection?
  2. Should back surgery be delayed due to preoperative steroid injections?
  3. What does the research say about the link between epidural steroid injections (ESI) and postoperative infection?

Doctor’s Tip

A doctor might tell a patient undergoing lumbar fusion surgery that having epidural steroid injections prior to the surgery does not necessarily increase the risk of postoperative infection. Therefore, they should not delay the surgery due to concerns about previous steroid injections. However, more research is needed to fully understand the relationship between epidural steroid injections and infection risk after back surgery.

Suitable For

Patients who are typically recommended lumbar fusion include those with severe back pain that does not improve with conservative treatments such as physical therapy, medication, and injections. Other indications for lumbar fusion include spinal instability, degenerative disc disease, spondylolisthesis, spinal stenosis, and spinal deformities. Patients with conditions such as herniated discs, fractures, tumors, and infections may also benefit from lumbar fusion surgery. It is important for patients to discuss their individual case with a spine specialist to determine if lumbar fusion is the most appropriate treatment option for their specific condition.

Timeline

Before lumbar fusion:

  1. Patient experiences chronic back pain and undergoes various conservative treatments such as physical therapy, medications, and injections.
  2. Patient’s condition worsens and they are recommended for lumbar fusion surgery by their healthcare provider.
  3. Patient undergoes preoperative testing and consultations to prepare for the surgery.
  4. Patient receives epidural steroid injections as part of their pain management before the surgery.

After lumbar fusion:

  1. Patient undergoes the lumbar fusion surgery, where the damaged disc in the spine is removed and replaced with bone graft.
  2. Patient stays in the hospital for a few days for monitoring and recovery.
  3. Patient is discharged from the hospital and begins the rehabilitation process, which includes physical therapy and gradually increasing activity levels.
  4. Patient experiences some pain and discomfort as they recover from the surgery.
  5. Patient gradually resumes normal activities and starts to see improvement in their back pain.
  6. Patient follows up with their healthcare provider for postoperative appointments to monitor their progress and address any concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about lumbar fusion in relation to epidural steroid injections include:

  1. Is there a risk of infection after lumbar fusion if I have had epidural steroid injections before the surgery?
  2. Are there any specific precautions or considerations I should be aware of if I have had epidural steroid injections prior to the surgery?
  3. How will my previous epidural steroid injections impact my recovery and healing process after lumbar fusion?
  4. Are there any alternative treatment options or modifications to the surgical approach that should be considered due to my history of epidural steroid injections?
  5. What is the overall success rate of lumbar fusion in patients who have had epidural steroid injections compared to those who have not?
  6. Are there any specific postoperative monitoring or follow-up recommendations for patients with a history of epidural steroid injections undergoing lumbar fusion surgery?

Reference

Authors: Lee Y, Issa TZ, Kanhere AP, Lambrechts MJ, Ciesielka KA, Kim J, Hilibrand AS, Kepler CK, Schroeder GD, Vaccaro AR, Canseco JA. Journal: Eur Spine J. 2022 Dec;31(12):3251-3261. doi: 10.1007/s00586-022-07436-z. Epub 2022 Nov 2. PMID: 36322212