Kelly H Yoo, Sina Sadeghzadeh, Aaryan Shah and Anand Veeravagu*
The management of lumbar spine disorders often require a multimodal approach, with surgery considered for those unresponsive to conservative treatments. Lumbar Epidural Steroid Injections (ESIs) are widely adopted for symptom alleviation and functional enhancement. While preoperative lumbar ESIs are proposed to enhance surgical outcomes, recent studies express concerns about complications, particularly an elevated risk of Postoperative Infections (POIs) due to corticosteroids.
The intricate link between preoperative lumbar ESIs and surgical outcomes has been extensively explored. Retrospective analyses indicate a noticeable reduction in preoperative pain scores post-ESIs, suggesting potential synergy with surgical outcomes. The anti-inflammatory and analgesic properties of ESIs may positively impact the perioperative period, though apprehensions persist about associated risks, including infection and delayed wound healing. Temporal considerations are crucial, with studies indicating an augmented risk of POIs when ESIs are administered within a month before lumbar spine surgeries. Moreover, elevated intraoperative Dural Tear (DT) has been observed within three months of post-ESI, attributed to steroid effects on local tissue, particularly collagen and fibroblasts. DT risk is higher in elderly patients with reduced capacity for efficient return to normal fibroblast function. Pragmatic clinical decision-making emphasizes strategic surgery delay after ESI to mitigate risks. Individualized considerations guided by shared decision-making become imperative for optimizing outcomes.
Further research is warranted, particularly through Randomized Controlled Trials (RCTs), to elucidate and refine the intricate relationship between preoperative lumbar ESIs and subsequent surgical outcomes. RCTs should encompass diverse outcome measures, beyond preoperative pain scores, including function improvement and complications. The implementation of standardized protocols in RCTs will contribute to evidence-based guidelines and serve as foundational pillars in optimizing patient care in lumbar spine surgery. In our review, we aim to explore the temporal aspects of lumbar ESIs and their impact on outcomes in lumbar spine surgery.
Published Date: 2024-01-04; Received Date: 2023-12-05
