Preoperative Epidural Steroid Injections in Posterior Cervical Fusion: Elevated Risks of Pseudarthrosis and Reoperation Without Increased Infection Rates.

STUDY

DESIGN

Retrospective cohort study.

OBJECTIVE

This study aimed to evaluate the influence of preoperative ESIs on postoperative complications in patients undergoing posterior cervical fusion (PCF).

BACKGROUND

Epidural steroid injections (ESIs) are commonly used to manage cervical radiculopathy symptoms before surgical intervention. However, concerns exist regarding their potential adverse impacts on postoperative outcomes, specifically infection rates and spinal fusion integrity.

METHODS

Utilizing a large retrospective database, we identified 63,132 patients undergoing elective PCF between 2015 and 2022. Patients were categorized into ESI and non-ESI cohorts based on injections received within 30 days before surgery. Propensity score matching balanced cohorts for demographics and comorbidities. Outcomes measured included infection rates, emergency department (ED) visits, and hospital readmissions at 30-day and 90-day intervals, and pseudarthrosis and reoperation rates at 1-year and 3-year follow-ups.

RESULTS

After matching, no significant differences emerged between cohorts for infection rates, ED visits, or readmissions at either 30-day or 90-day follow-up (all P > 0.05). However, the ESI cohort demonstrated significantly increased pseudarthrosis incidence at 1-year (RR=1.298, P=0.007) and 3-year (RR=1.432, P<0.001) follow-ups compared with non-ESI controls. Reoperation rates at 3 years were significantly higher in the ESI group in unmatched analyses (RR=1.320, P<0.001) and approached statistical significance after propensity score matching (RR=1.565, P=0.06).

CONCLUSIONS

While preoperative ESIs did not increase short-term complications or health care utilization, their use was associated with significantly elevated risks of pseudarthrosis and a trend towards increased long-term reoperation rates following PCF. Surgeons should carefully consider these potential long-term implications when integrating ESIs into preoperative management for cervical radiculopathy.

LEVEL OF EVIDENCE: Therapeutic Level III.