Resident Ochsner Clinic Foundation New Orleans, LA, US
Introduction: Epidural steroid injections (ESI) are a commonly used tool in the the conservative management of spine conditions. The impact of their use has been well studied; however, the effects of multiple injections on post operative outcomes remains a question. The authors of this systematic literature review seek to clarify if there is evidence to suggest a correlation between the number of ESI on post operative outcomes in spine surgery.
Methods: The PubMed database was searched with MESH terms: preoperative lumbar epidural steroid injections AND re-operation or infection or complication or surgical time or blood loss or healing. This search resulted in 38 relevant papers. Inclusion criteria included English language papers discussing or evaluating the patient specific number of epidural steroid injections and postoperative infection, wound healing, surgical complications, or re-operation. Exclusion criteria were papers solely evaluating nonsurgical patients, papers that did not include a specific number of prior ESIs, or the complications, infections, and wound healing relating to the epidural steroid injection itself.
Results: Five papers were found to meet the criteria for this literature review. Of the literature reviewed, over 1300 patients were evaluated comparing the outcome of post operative infections, re- operation rates, and the effect of temporality from injection to surgery on duration of surgery and blood loss.
Conclusion : Based on the available literature, there is a minimal increase in risk of infection related to receiving ESI within 3 months of surgery, so there could be a temporal correlation between injection timing and surgery. However, the amount of ESIs as well as methodology of injection has yet to be adequately studied, and patients could benefit from focused research on outcomes related to total number of ESI and post operative outcomes.
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