Preoperative Epidural Steroid Injection Does Not Increase Infection Risk Following Posterior Cervical Surgery.

Abstract

Retrospective cohort study. The purpose of this study was to characterize infection risk of preoperative epidural steroid injection (ESI) in patients undergoing posterior cervical surgery. ESI is a helpful tool for alleviating pain and is often used as a diagnostic tool prior to cervical surgery. However, a recent small-scale study found that ESI prior to cervical fusion was associated with an increased risk of postoperative infection. Patients from 2010-2020 with cervical myelopathy, spondylosis, and radiculopathy who underwent posterior cervical procedure including laminectomy, laminoforaminotomy, fusion, or laminoplasty were queried from the PearlDiver database. Patients who underwent revision or fusion above C2 or who had a diagnosis of neoplasm, trauma, or pre-existing infection were excluded. Patients were divided on whether they received an ESI within 30 days prior to the procedure and subsequently matched by age, gender, and preoperative comorbidities. Chi-squared analysis was used to calculate risk of postoperative infection within 90 days. Logistic regression controlling for age, sex, ECI, and operated levels was conducted within the unmatched population to assess infection risk for injected patients across procedure subgroups. Overall, 299417 patients were identified with 3897 having received a preoperative ESI and 295520 who did not. Matching resulted in 975 in the injected group and 1,929 in the control group. There was no significant difference in postoperative infection rate in those who received an ESI within 30 days preoperatively and those who did not (3.28% vs. 3.78%, OR=0.86, 95% CI: 0.57-1.32, P=0.494). Logistic regression accounting for age, gender, ECI, and levels operated demonstrated that injection did not significantly increase infection risk in any of the procedure subgroups. The present study found no association between preoperative ESI within 30 days prior to surgery and postoperative infection in patients undergoing posterior cervical surgery.