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The Effects of Preoperative Epidural Steroid Injection on Pseudarthrosis Following Lumbar Fusion: A Retrospective Cohort Study – Lumbar Fusion

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This article is a retrospective cohort study that evaluates the effects of preoperative lumbar epidural steroid injection (ESI) on the rate of pseudarthrosis following lumbar spine fusion surgery. Pseudarthrosis is the incomplete fusion or failure of fusion of the bones in the spine. Epidural corticosteroids are known to reduce inflammation and swelling in patients with radiculopathy, but there is concern that they may inhibit bone formation and reduce the success of fusion. The study analyzed data from 446 patients who underwent 1-level or 2-level lumbar fusion surgery and categorized them into three groups based on their ESI history. The overall incidence of pseudarthrosis was 8.7%, but there was no significant difference in the incidence between the groups. Therefore, the study concludes that preoperative ESI does not increase the risk of postoperative pseudarthrosis in patients undergoing lumbar fusion surgery

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

S: This study found no increased risk of postoperative pseudarthrosis in patients who underwent 1-level or 2-level lumbar fusions after preoperative ESI.

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Clin Spine Surg. 2024 Jan 5. doi: 10.1097/BSD.0000000000001569. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective cohort study.OBJECTIVE: The goal of this study is to evaluate the effects of preoperative lumbar epidural steroid injection on the rate of pseudarthrosis following lumbar spine fusion surgery.SUMMARY OF BACKGROUND DATA: Epidural corticosteroids help to reduce nerve root edema and suppress,

Clin Spine Surg. 2024 Jan 5. doi: 10.1097/BSD.0000000000001569. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: The goal of this study is to evaluate the effects of preoperative lumbar epidural steroid injection on the rate of pseudarthrosis following lumbar spine fusion surgery.

SUMMARY OF BACKGROUND DATA: Epidural corticosteroids help to reduce nerve root edema and suppress proinflammatory cytokines in patients with radiculopathy. Corticosteroids may inhibit bone formation and reduce bone matrix synthesis rates. Thus, there is concern that corticosteroids may reduce lumbar fusion capability, potentially resulting in increased rates of symptomatic pseudarthrosis.

MATERIALS AND METHODS: We identified all patients who underwent 1-level or 2-level lumbar fusion surgery between 2018 and 2022. Patients were categorized into one of 3 groups: no preoperative epidural steroid injection (ESI) history (group 0), preoperative ESI within 90 days of surgery (group 1), or most recent ESI >90 days before surgery (group 2). The primary outcome of this study was pseudarthrosis. Binominal regression analyses were performed to determine the relationships between potential risk factors (sex, age, body mass index, smoking history, diabetes status, history of systemic steroid use, preoperative ESI, perioperative intravenous steroid administration, type of surgery, and postoperative ESI within 6 mo) and the development of postoperative pseudarthrosis.

RESULTS: A total of 446 patients were included in this study. Of those, 106 patients (23.7%) did not have a preoperative ESI (group 0), 132 patients (29.5%) had an ESI within 90 days of surgery (group 1), and 208 patients (46.6%) had their most recent ESI >90 days before surgery (group 2). The overall incidence of pseudarthrosis following lumbar fusion was 8.7% (39 of 446). Although the incidence of pseudarthrosis following ESI at any time point was higher than in our control cohort (group 0), this difference was not statistically significant.

S: This study found no increased risk of postoperative pseudarthrosis in patients who underwent 1-level or 2-level lumbar fusions after preoperative ESI.

LEVEL OF EVIDENCE: Level III.

PMID:38178309 | DOI:10.1097/BSD.0000000000001569

The London Spine Unit : best recognised treatment facility in London

Read the original publication:

The Effects of Preoperative Epidural Steroid Injection on Pseudarthrosis Following Lumbar Fusion: A Retrospective Cohort Study

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Clin Spine Surg. 2024 Jan 5. doi: 10.1097/BSD.0000000000001569. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective cohort study.OBJECTIVE: The goal of this study is to evaluate the effects of preoperative lumbar epidural steroid injection on the rate of pseudarthrosis following lumbar spine fusion surgery.SUMMARY OF BACKGROUND DATA: Epidural corticosteroids help to reduce nerve root edema and suppress

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