The effect of preoperative lumbar epidural corticosteroid injection on postoperative infection rate in patients undergoing single-level lumbar decompression

Seavey, Jonathan G.; Balazs, George C.; Steelman, Theodore; Helgeson, Melvin D.; Gwinn, David E.; Wagner, Scott C.

doi:10.1016/j.spinee.2017.04.003

Cited by 34 publications

(51 citation statements)

References 29 publications

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“…It often causes pain in the low back and legs, di culty in walking, paruria and even paraplegia (8). Early patients are usually treated conservatively with NSAIDs, physical therapy, epidural injections, lifestyle improvements, and comprehensive rehabilitation (9,10) and patients who fail to respond to conservative treatment should be treated with surgery (11,12). Traditional surgical methods include laminectomy, hemilaminectomy, and lumbar interbody fusion, which focus on complete decompression with signi cant results.…”

Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Treatment for Lumbar Spinal Stenosis Secondary to Ligamentum Flavum Hypertrophy Using Percutaneous Endoscopy through Interlaminar Approach: A Retrospective Study

Liu

Diaty

et al. 2020

Preprint

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Background: This paper is to describe percutaneous endoscopy in the treatment of lumbar spinal stenosis secondary to ligamentum flavum hypertrophy targeted. To investigate the efficacy and safety of percutaneous endoscopy in the treatment of this kind of lumbar spinal stenosis in elderly patients.Method: A retrospective analysis of 40 elderly patients with lumbar spinal stenosis secondary to ligamentum flavum hypertrophy admitted between January 2016 and January 2018 was performed. According to different surgical methods, they were divided into two groups: the control group and the endoscopy group (interlaminar approach), 20 people per group. There were 9 males and 11 females in the control group; the age of patients was 65.65±4.44years, and the average disease duration was 4.55±1.85 years. Besides, There were 10 males and 10 females in the endoscopy group; the age of patients was 67.30±4.23years, and the average disease duration was 4.95±2.04 years. Collect and count surgical-related indicators, preoperative and postoperative radiologic findings, incision visual analogue scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) scores of all patients.Result: A series of surgical indicators (including the operation time, the quantity of bleeding and postoperative hospital stay) in the endoscopy group was significantly lower than that in the control group (p < 0.05). The incision VAS score in the endoscopy group was also significantly lower than that in the control group at each time after surgery (p < 0.05). Besides, compared with the control group, in the endoscopy group, the leg pain VAS score and lumbar ODI score after surgery were significantly decreased (p < 0.05). Compared with the control group, in the endoscopy group, the lumbar JOA score was significantly higher (p < 0.05).Conclusion: Percutaneous endoscopic technique is a small trauma, quick recovery, safe and effective minimally invasive surgery for patients with lumbar spinal stenosis secondary to ligamentum flavum hypertrophy.

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Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Treatment for Lumbar Spinal Stenosis Secondary to Ligamentum Flavum Hypertrophy Using Percutaneous Endoscopy through Interlaminar Approach: A Retrospective Study

Liu

Diaty

et al. 2020

Preprint

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“…Predictors of infection following microdiscectomy include absence of prophylactic antibiotic dosing and duration of surgery > 68 min [90]. Interestingly, one study did not find that preoperative lumbar epidural CSI increased infection risk [91]. Kotil et al evaluated 115 patients undergoing single-level discectomy with and without closed suction drains.…”

Section: Open Discectomymentioning

confidence: 99%

Lumbar Disc Herniation

Amin

Andrade

Neuman³

2017

Curr Rev Musculoskelet Med

225

202

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Purpose of Review Substantial advancements have been made in the cause, diagnosis, imaging, and treatment options available for patients with lumbar disc herniation (LDH). We examined the current evidence and highlight the concepts on the frontline of discovery in LDH. Recent Findings There are a myriad of novel etiologies of LDH detailed in recent literature including inflammatory factors and infectious microbes. In the clinical setting, recent data focuses on improvements in computer tomography as a diagnostic tool and non-traditional injection options including tumor necrosis alpha inhibitors and platelet-rich plasma. Operative treatment outcomes have focused on minimally invasive endoscopic approaches and demonstrated robust 5-year post-operative outcomes. Summary Advances in the molecular etiology of LDH will continue to drive novel treatment options. The role of endoscopic treatment for LDH will continue to evolve. Further research into10-year outcomes will be necessary as this surgical approach continues to gain widespread popularity.

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“…In 18 931 patients aged 65 years old and older who underwent a single‐level lumbar decompression surgery within 1 year of ESI, the incidence of postoperative infection was significantly greater in those receiving an ESI within 1 to 3 months prior to surgery (1 month OR = 3.2, 1 to 3 months OR = 1.3) . A study of 847 patients in the military health system who received ESI within 90 days of surgery demonstrated an increased odds ratio of 1.57 for injected patients compared to controls . A study of surgery with or without the use of epidural steroid paste to control pain during lumbar decompression surgery in 283 patients documented that there was an increased incidence of infections in the patients receiving paste compared to the nonpaste group (odds ratio 6.4) .…”

Section: Clinical Effectsmentioning

confidence: 99%

“…66 A study of 847 patients in the military health system who received ESI within 90 days of surgery demonstrated an increased odds ratio of 1.57 for injected patients compared to controls. 67 A study of surgery with or without the use of epidural steroid paste to control pain during lumbar decompression surgery in 283 patients documented that there was an increased incidence of infections in the patients receiving paste compared to the nonpaste group (odds ratio 6.4). 68 The risk of postoperative infection in lumbar fusion after preoperative ESI has also been retrospectively evaluated in 88 540 patients.…”

Section: Bone Metabolismmentioning

confidence: 99%

Systemic Absorption and Side Effects of Locally Injected Glucocorticoids

Stout

Friedly

Standaert

2019

PM&R

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Local glucocorticoid injections are often used to treat joint, soft tissue, or spinal pain, but the systemic side effects associated with these injections are poorly understood and not well recognized. There are significant known risks to systemic administration of glucocorticoids. However, there are no guidelines that address issues of systemic absorption, overall systemic risks, or other side effects of locally injected glucocorticoids. For this review, a literature search was performed, and the available evidence on systemic absorption and clinical side effects of intra‐articular and epidural glucocorticoids was synthesized. The goal was to improve clinical understanding of risks associated with these injections. Existing data suggest there is significant individual variability in the amount of systemic absorption and clinical effects of locally injected glucocorticoids. However, it is clear that both intra‐articular and epidural injections can have systemic effects for weeks and that complications may be associated with their use, including Cushing syndrome, loss of bone density, infection, and hyperglycemia. The concurrent use of oral steroids, the number of injections, and the type and dose of glucocorticoids used all are important considerations in estimating risks. The total dose calculation of cumulative glucocorticoid exposure should include all local injections. Caution should be exercised when local glucocorticoid injections are used in higher risk patients, such as postmenopausal women, people with diabetes, and those considering surgery in the near term. Better provider awareness of possible systemic risks should improve decision making and informed consent with patients when considering intra‐articular and epidural steroid injections for painful conditions. Level of Evidence IV

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The effect of preoperative lumbar epidural corticosteroid injection on postoperative infection rate in patients undergoing single-level lumbar decompression

Cited by 34 publications

References 29 publications

WITHDRAWN: Treatment for Lumbar Spinal Stenosis Secondary to Ligamentum Flavum Hypertrophy Using Percutaneous Endoscopy through Interlaminar Approach: A Retrospective Study

WITHDRAWN: Treatment for Lumbar Spinal Stenosis Secondary to Ligamentum Flavum Hypertrophy Using Percutaneous Endoscopy through Interlaminar Approach: A Retrospective Study

Lumbar Disc Herniation

Systemic Absorption and Side Effects of Locally Injected Glucocorticoids

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