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Impact of preoperative spinal injections within 30 days of lumbar decompression on surgical outcomes: a matched institutional study – Lumbar Spinal Stenosis

This article examines the impact of the temporal proximity of lumbar epidural spinal injection prior to surgery on clinical outcomes in patients undergoing lumbar decompression without fusion. The study analyzed data from patients who underwent elective lumbar decompression between January 2019 and March 2022. Patients were divided into three groups based on the time between their surgical date and their most recent preoperative spinal injection: less than 1 month, 1-3 months, and no injection within 3 months. The study found that patients who received spinal injections less than 1 month before surgery had higher risks of postoperative complications, readmission, and CSF (cerebrospinal fluid) leak compared to those with no prior injection. However, these risks were not observed when the spinal injection occurred 1-3 months before surgery, except for CSF leak. Overall, the study suggests that lumbar decompression within 1 month of preoperative spinal injection is associated with higher risks, but these risks decrease when the injection is given 1-3 months prior to surgery

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : innovative treatment clinic in UK

Published article

CONCLUSIONS: Lumbar decompression within 1 month of preoperative spinal injection was associated with higher risks of readmission and postoperative complications, including CSF leak. However, with the exception of CSF leak, these risks were no longer observed when spinal injection occurred 1-3 months prior to lumbar decompression.

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J Neurosurg Spine. 2023 Aug 11:1-8. doi: 10.3171/2023.6.SPINE23356. Online ahead of print.ABSTRACTOBJECTIVE: The authors sought to determine how the temporal proximity of lumbar epidural spinal injection prior to surgery impacts clinical outcomes (e.g., 30-day readmission, postoperative complications, CSF leak) in patients undergoing lumbar decompression without fusion.METHODS: The authors queried their institutional registry to identify patients,

J Neurosurg Spine. 2023 Aug 11:1-8. doi: 10.3171/2023.6.SPINE23356. Online ahead of print.

ABSTRACT

OBJECTIVE: The authors sought to determine how the temporal proximity of lumbar epidural spinal injection prior to surgery impacts clinical outcomes (e.g., 30-day readmission, postoperative complications, CSF leak) in patients undergoing lumbar decompression without fusion.

METHODS: The authors queried their institutional registry to identify patients who underwent elective lumbar decompression for spondylotic pathology between January 2019 and March 2022 at multiple centers within the same hospital network. Patients were divided into groups based on the time between their surgical date and the most recent preoperative spinal injection: group 1, patients with duration < 1 month; group 2, 1-3 months; and group 3, no spinal injection within 3 months. Primary outcomes of interest were the length of hospital stay, postoperative complications, rate of intraoperative CSF leak, and rates of reoperation and hospital readmission. For patients in groups 1 and 2, the authors also recorded the number of injections within 12 months prior to surgery to better understand the effect of multiple recent injections. The independent Student t-test and Pearson's chi-square test were mainly performed for univariate analyses of the continuous and categorical variables, respectively.

RESULTS: A total of 121 and 283 patients received a spinal injection at < 1 month and 1-3 months prior to surgery, respectively, and were separately matched in a 3:1 ratio with 2562 patients with no history of preoperative spinal injection within 3 months before surgery. Among the matched cohorts, patients who received spinal injections < 1 month before lumbar decompression had significantly higher risks of 30-day complication (7.4% vs 0.8%, OR 9.6, p < 0.001), 30-day readmission (5.8% vs 2.2%, OR 3.5, p = 0.049), and 90-day readmission (9.1% vs 2.8%, OR 3.5, p = 0.003) than patients with no history of spinal injection. However, compared with patients with no history of spinal injection, the patients who received spinal injections 1-3 months before surgery were not at higher risk for postoperative complications or readmission. The CSF leak rates were significantly different between the three patient cohorts (10.7% vs 6.7% vs 4.9% for the < 1 month, 1-3 months, and no injection cohorts, respectively; p = 0.02).

CONCLUSIONS: Lumbar decompression within 1 month of preoperative spinal injection was associated with higher risks of readmission and postoperative complications, including CSF leak. However, with the exception of CSF leak, these risks were no longer observed when spinal injection occurred 1-3 months prior to lumbar decompression.

PMID:37728375 | DOI:10.3171/2023.6.SPINE23356

The London Spine Unit : innovative treatment clinic in UK

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Impact of preoperative spinal injections within 30 days of lumbar decompression on surgical outcomes: a matched institutional study

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J Neurosurg Spine. 2023 Aug 11:1-8. doi: 10.3171/2023.6.SPINE23356. Online ahead of print.ABSTRACTOBJECTIVE: The authors sought to determine how the temporal proximity of lumbar epidural spinal injection prior to surgery impacts clinical outcomes (e.g., 30-day readmission, postoperative complications, CSF leak) in patients undergoing lumbar decompression without fusion.METHODS: The authors queried their institutional registry to identify patients

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