Epidural Steroid Injection Before Spine Surgery May Boost Infection Risk

Study cautions against injections within three months before a lumbar fusion.

Peer Reviewed

If you recently had a lumbar epidural steroid injection (LESI) to help manage your low back or leg pain, you may want to wait a few months before considering surgery. New research shows that having a LESI shortly before spinal fusion could increase your risk of an infection after surgery, according to a study published online in March 2017 in the Journal of Neurosurgery: Spine

Researchers found patients who had LESI within three months of their surgery had a higher risk of developing an infection after surgery—with the highest risk occurring when the injection was administered one month before spinal fusion surgery.
Back pain information with pills and a syringe in the background Epidural Steroid Injections: Widely Used but Not Perfect
LESIs are the most common nonsurgical treatment for lumbar spinal stenosis and radiculopathy. The study noted that rates of transforaminal LESIs have skyrocketed 665 percent since 2000—with more than 2.2 million procedures performed each year in the Medicare population alone.

The injections send anti-inflammatory medicine into the epidural space, the area surrounding your spinal cord through which your spinal nerve roots pass. The medicine reduces nerve inflammation, problems with blood supply, and pain.

While LESIs are considered a safe treatment and diagnostic tool, they come with risks, including infection and nerve damage. This study shed light on the role injection timing plays in infection risk after surgery.

Study Details
The researchers used a large, nationwide patient database of Medicare patients 65 and older who had a one-level or two-level lumbar spinal fusion between 2005 to 2012. The authors identified 88,540 patients and broke them into three groups:

  1. Those who had a lumbar spinal fusion performed within one month after an injection (1,699 patients).
  2. Those who had a lumbar spinal fusion performed between one and three months after an injection (5,491 patients).
  3. Those who had a lumbar spinal fusion performed between three and six months after an injection (10,493 patients).

The patients in the three groups were then compared to patients who had lumbar fusion without an injection (70,857 patients).

Patients who received LESI within one month of spine surgery had the highest infection risk of all the groups—3.9 percent of those patients developed an infection after their spinal fusion. For those who had a LESI one to three months before surgery, the risk was 2.2 percent, and patients having LESI three to six months before fusion had a 1.3 percent infection rate.

The infection rate was significantly higher in both groups of patients who had an injection within three months before surgery compared to the patients who did not have an injection prior to surgery. Those who had an injection more than three months before their spinal fusion did not have a significantly higher infection risk compared to the patients who didn’t have an injection.

What You Should Know as a Patient
The findings suggest a strong association between spine surgery within three months of a LESI and postoperative infections. With that said, patients should work with their medical team to time injection treatment and surgery appropriately to reduce their risk of infection after surgery.

“Unless a patient is experiencing acute neurological deficits or debilitating pain, it is likely best to wait at least 12 weeks after an injection before lumbar spine fusion surgery is performed,” says SpineUniverse Editorial Board member Ali A. Baaj, MD, Assistant Professor of Neurological Surgery at Cornell University’s Weill Cornell Medical College in New York, NY, who shared his comments on this study.

“I encourage patients and surgeons alike to discuss the risks of postoperative infections after lumbar spinal fusion surgery, as well to coordinate timing of injections accordingly,” Dr. Baaj continues.

To learn more about lumbar epidural steroid injections and how this treatment manages back and leg pain, read Epidural Corticosteroid Injections and Low Back Pain.

Updated on: 04/06/17
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Safe Medication Use Before Spine Surgery
Ali A. Baaj, MD
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